Healthcare Provider Details

I. General information

NPI: 1801619697
Provider Name (Legal Business Name): FNU BLANDINE MBI TABOT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2024
Last Update Date: 11/01/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 1ST ST NE
WASHINGTON DC
20002-4243
US

IV. Provider business mailing address

8853 GARLAND AVE
SILVER SPRING MD
20901-3876
US

V. Phone/Fax

Practice location:
  • Phone: 202-506-1209
  • Fax:
Mailing address:
  • Phone: 240-797-7680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200003984
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: