Provider Demographics
NPI:1629489521
Name:TEBOR, JULIE LYNN (CRNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:LYNN
Last Name:TEBOR
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10110 MOLECULAR DR
Mailing Address - Street 2:SUITE #206
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-7539
Mailing Address - Country:US
Mailing Address - Phone:301-279-2779
Mailing Address - Fax:240-403-0190
Practice Address - Street 1:10110 MOLECULAR DR STE 206
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-7542
Practice Address - Country:US
Practice Address - Phone:301-279-2779
Practice Address - Fax:240-403-0190
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR187504363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care