Individual
DESTAIRE NGOLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DN
Contact information
Practice address
2918 MINNESOTA AVE SE, WASHINGTON, DC 20019-1127
(202) 839-5310
Mailing address
1418 GOOD HOPE RD SE, WASHINGTON, DC 20020-5615
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
DC
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
91380925501
—
MD
Enumeration date
09/12/2022
Last updated
10/03/2024
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