Provider Demographics
NPI:1760205603
Name:TEBO, JUSTINE ENDAM
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:ENDAM
Last Name:TEBO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 POE CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2107
Mailing Address - Country:US
Mailing Address - Phone:240-855-4973
Mailing Address - Fax:
Practice Address - Street 1:3800 POE CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-2107
Practice Address - Country:US
Practice Address - Phone:240-855-4973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide