Provider Demographics
NPI:1750035010
Name:TEBID, WILSON ENYONG
Entity Type:Individual
Prefix:
First Name:WILSON
Middle Name:ENYONG
Last Name:TEBID
Suffix:
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 1:3500 14TH ST NW APT 605
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-1358
Mailing Address - Country:US
Mailing Address - Phone:240-413-9164
Mailing Address - Fax:
Practice Address - Street 1:3500 14TH ST NW APT 605
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-1358
Practice Address - Country:US
Practice Address - Phone:240-413-9164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide