Healthcare Provider Details

I. General information

NPI: 1275040073
Provider Name (Legal Business Name): WINIFRED AABEN TEMBAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2018
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 MARTIN LUTHER KING JR HWY
CAPITOL HEIGHTS MD
20743-2156
US

IV. Provider business mailing address

5701 MARTIN LUTHER KING JR HWY
CAPITOL HEIGHTS MD
20743-2156
US

V. Phone/Fax

Practice location:
  • Phone: 240-481-6288
  • Fax:
Mailing address:
  • Phone: 240-481-6288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberDC13394
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: