Provider Demographics
NPI:1679835698
Name:TANGYIE-CHE NIBA, STAR (NP)
Entity Type:Individual
Prefix:
First Name:STAR
Middle Name:
Last Name:TANGYIE-CHE NIBA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1247 APOLLO DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-1247
Mailing Address - Country:US
Mailing Address - Phone:240-676-7213
Mailing Address - Fax:
Practice Address - Street 1:10490 LITTLE PATUXENT PKWY STE 600
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-4941
Practice Address - Country:US
Practice Address - Phone:240-676-7213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR215105363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD987384800Medicaid