Provider Demographics
NPI:1568845089
Name:GARBA, TEHARAI
Entity Type:Individual
Prefix:MS
First Name:TEHARAI
Middle Name:
Last Name:GARBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 HAMMOND MANOR DR
Mailing Address - Street 2:APT A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-5526
Mailing Address - Country:US
Mailing Address - Phone:225-650-8685
Mailing Address - Fax:
Practice Address - Street 1:833 HAMMOND MANOR DR
Practice Address - Street 2:APT A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-5526
Practice Address - Country:US
Practice Address - Phone:225-650-8685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA110330376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA474030946OtherEIN