MEDICARE: ETIN ENDAH-NGUM TABREY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1457205197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ETIN ENDAH-NGUM TABREY

Provider Business Mailing Address
First Line	:	5120 SARGENT RD NE APT 203
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20017-2830
Country	:	US
Telephone Number	:	301-875-2328
Fax Number	:

Provider Business Practice Location Address
First Line	:	5120 SARGENT RD NE APT 203
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20017-2830
Country	:	US
Telephone Number	:	301-875-2328
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2026
Last Update Date	:	02/20/2026

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Directions to “ ETIN ENDAH-NGUM TABREY ” Practice Location

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