Healthcare Provider Details

I. General information

NPI: 1265119879
Provider Name (Legal Business Name): MAUREEN EBAH ESABE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1137 BENJAMIN AVE
ALBANY GA
31707-3933
US

IV. Provider business mailing address

1137 BENJAMIN AVE
ALBANY GA
31707-3933
US

V. Phone/Fax

Practice location:
  • Phone: 229-407-5462
  • Fax:
Mailing address:
  • Phone: 229-407-5462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN173892
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: