Healthcare Provider Details

I. General information

NPI: 1639623036
Provider Name (Legal Business Name): MS. REBA SEABORN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2016
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 15TH ST SE
WASHINGTON DC
20003-1519
US

IV. Provider business mailing address

401 13TH ST NE APT 204
WASHINGTON DC
20002-6316
US

V. Phone/Fax

Practice location:
  • Phone: 202-459-9908
  • Fax:
Mailing address:
  • Phone: 804-495-5810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA12119
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: