Provider Demographics
NPI:1093497091
Name:EBWELLE, LEO NKUMBE
Entity Type:Individual
Prefix:
First Name:LEO
Middle Name:NKUMBE
Last Name:EBWELLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10401 SWEETBRIAR PKWY
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-1526
Mailing Address - Country:US
Mailing Address - Phone:515-822-7212
Mailing Address - Fax:
Practice Address - Street 1:10401 SWEETBRIAR PKWY
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-1526
Practice Address - Country:US
Practice Address - Phone:515-822-7212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator