Healthcare Provider Details

I. General information

NPI: 1790609683
Provider Name (Legal Business Name): UMAR TEBUSEKE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 HARVARD RD
SHIRLEY MA
01464-2437
US

IV. Provider business mailing address

73 HARVARD RD
SHIRLEY MA
01464-2437
US

V. Phone/Fax

Practice location:
  • Phone: 857-249-1588
  • Fax:
Mailing address:
  • Phone: 857-249-1588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN2371649
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN2371649
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN2371649
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: