Individual
GHISLAINE KENMEGNE DATOUO MOGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4130 HUNT PL NE, WASHINGTON, DC 20019-3565
(202) 679-0620
Mailing address
9580 MUIRKIRK RD APT 101, LAUREL, MD 20708-2717
(240) 705-1096
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN1028252
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000-000-000
—
DC
Enumeration date
10/15/2019
Last updated
10/15/2019
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