Provider Demographics
NPI:1609511328
Name:ITAMBI PRECIOUS, AMBOH
Entity Type:Individual
Prefix:
First Name:AMBOH
Middle Name:
Last Name:ITAMBI PRECIOUS
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 1:9765 LADY SLIPPER CT APT 3D
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-6342
Mailing Address - Country:US
Mailing Address - Phone:240-761-0228
Mailing Address - Fax:
Practice Address - Street 1:9765 LADY SLIPPER CT APT 3D
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-6342
Practice Address - Country:US
Practice Address - Phone:240-761-0228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide