Provider Demographics
NPI:1831499904
Name:TEBEPAH, JOHN ODOUN (RN)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ODOUN
Last Name:TEBEPAH
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 PENNSYLVANIA AVE APT 17C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11239-1105
Mailing Address - Country:US
Mailing Address - Phone:347-595-0208
Mailing Address - Fax:718-940-9240
Practice Address - Street 1:123 LINDEN BLVD FL 3
Practice Address - Street 2:FAMILY SERVICES NETWORK
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-3888
Practice Address - Country:US
Practice Address - Phone:718-940-9040
Practice Address - Fax:718-940-9240
Is Sole Proprietor?:No
Enumeration Date:2010-10-23
Last Update Date:2010-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY632049163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse