Provider Demographics
NPI:1154639235
Name:TEBEBO, FUNMILAYO MERCY (LPN)
Entity Type:Individual
Prefix:MISS
First Name:FUNMILAYO
Middle Name:MERCY
Last Name:TEBEBO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 LEFFERTS AVE
Mailing Address - Street 2:APT 1F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-1050
Mailing Address - Country:US
Mailing Address - Phone:347-285-1631
Mailing Address - Fax:
Practice Address - Street 1:570 LEFFERTS AVE
Practice Address - Street 2:APT 1F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1050
Practice Address - Country:US
Practice Address - Phone:347-285-1631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301498164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse