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General NPI Number Information
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NPI Number | 1497414296
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Entity Type | Individual
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Provider Name | COLETTE ACHE TEBONG-HOSEL
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Gender | Female
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Dates
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Enumeration Date | 12/09/2021
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Last Update Date | 01/16/2023
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Provider Practice Location Address
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Address Line | 1515 MARTIN BLVD
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City | MIDDLE RIVER
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State | MD
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Zip | 21220-4103
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Country | US
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Telephone | 410-870-4983
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Fax |
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Provider Business Mailing Address
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Address Line | 7814 LOBLOLLY WAY
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City | HANOVER
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State | MD
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Zip | 21076-2180
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | R162723
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 2084P0015X
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Taxonomy Name | Psychosomatic Medicine Physician
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License Number | R162723
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License Number State | MD
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