Healthcare Provider Details

I. General information

NPI: 1437671245
Provider Name (Legal Business Name): FNU CECILIA ENEKE TABE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2017
Last Update Date: 07/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 12TH ST SE STE G35
WASHINGTON DC
20003-3738
US

IV. Provider business mailing address

2400 QUEENS CHAPEL RD APT 207
HYATTSVILLE MD
20782-3632
US

V. Phone/Fax

Practice location:
  • Phone: 202-544-8090
  • Fax: 202-544-8091
Mailing address:
  • Phone: 240-918-7446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA12908
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: