Provider Demographics
NPI:1457085383
Name:TEBO, SEVERIN NJECK SR
Entity Type:Individual
Prefix:
First Name:SEVERIN
Middle Name:NJECK
Last Name:TEBO
Suffix:SR
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 1:11329 COLUMBIA PIKE
Mailing Address - Street 2:APT C6
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904
Mailing Address - Country:US
Mailing Address - Phone:202-316-5676
Mailing Address - Fax:
Practice Address - Street 1:11329 COLUMBIA PIKE APT C6
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2505
Practice Address - Country:US
Practice Address - Phone:202-316-5676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-15
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA200001966374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide