Individual ProviderDieudonne MetombeNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address9906 Stall Ave, Lanham, MD 20706-2379(513) 371-2802PECOS EnrollmentBased on the most recent information from CMS, provider Dieudonne Metombe is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1457610263Provider TypeIndividualFull NameMetombe, DieudonneCredentialLPNGenderMaleSole ProprietorYesEnumeration Date5/14/2012Last Updated2/8/2024Contact InformationPractice LocationPractice Address9906 Stall Ave, Lanham, MD 20706-2379Phone(513) 371-2802FaxUnlisted FaxMailing LocationMailing Address9906 Stall Ave, Lanham, MD 20706-2379Phone(513) 371-2802FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363LP0808XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseR227138MarylandCode164W00000XDescriptionLicensed Practical NurseNursing Service ProvidersLicense135231Ohio