MEDICARE: SIMON PIERRE NINIMBA TEKO HHA

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1790036622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIMON PIERRE NINIMBA TEKO HHA

Provider Business Mailing Address
First Line	:	621 SHERIDAN ST APT 11
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20783-3212
Country	:	US
Telephone Number	:	202-545-0935
Fax Number	:	202-545-0176

Provider Business Practice Location Address
First Line	:	621 SHERIDAN ST APT 11
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20783-3212
Country	:	US
Telephone Number	:	202-545-0935
Fax Number	:	202-545-0176

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

Provider Enumeration Date	:	10/02/2012
Last Update Date	:	10/02/2012

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