Provider Demographics
NPI:1346605748
Name:AMBE, NEBA
Entity Type:Individual
Prefix:
First Name:NEBA
Middle Name:
Last Name:AMBE
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 1:2844 W SHERWIN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-1238
Mailing Address - Country:US
Mailing Address - Phone:773-931-3026
Mailing Address - Fax:
Practice Address - Street 1:2844 W SHERWIN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-1238
Practice Address - Country:US
Practice Address - Phone:773-931-3026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide