Provider Demographics
NPI:1013554195
Name:TABANSI, MAUREEN O
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:O
Last Name:TABANSI
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 1:14615 LONDON LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-2577
Mailing Address - Country:US
Mailing Address - Phone:301-906-0375
Mailing Address - Fax:
Practice Address - Street 1:2131 O ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1008
Practice Address - Country:US
Practice Address - Phone:202-785-2577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-07
Last Update Date:2019-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1033562363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty