Provider Demographics
NPI:1407468739
Name:MESUMBE, EBAKO HENRY
Entity Type:Individual
Prefix:
First Name:EBAKO
Middle Name:HENRY
Last Name:MESUMBE
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 1:60 OAK ST
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-2745
Mailing Address - Country:US
Mailing Address - Phone:617-216-7555
Mailing Address - Fax:
Practice Address - Street 1:60 OAK ST
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-2745
Practice Address - Country:US
Practice Address - Phone:617-216-7555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No376K00000XNursing Service Related ProvidersNurse's Aide