Healthcare Provider Details

I. General information

NPI: 1013554195
Provider Name (Legal Business Name): MAUREEN O TABANSI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2019
Last Update Date: 12/07/2019
Certification Date: 12/07/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 O ST NW
WASHINGTON DC
20037-1008
US

IV. Provider business mailing address

14615 LONDON LN
BOWIE MD
20715-2577
US

V. Phone/Fax

Practice location:
  • Phone: 202-785-2577
  • Fax:
Mailing address:
  • Phone: 301-906-0375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN1033562
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: