Provider Demographics
NPI:1932666021
Name:TABE-EBOB, MELVIS A
Entity Type:Individual
Prefix:
First Name:MELVIS
Middle Name:A
Last Name:TABE-EBOB
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 1:9110 BRIARCHIP ST
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-1304
Mailing Address - Country:US
Mailing Address - Phone:240-602-0591
Mailing Address - Fax:
Practice Address - Street 1:6856 EASTERN AVE NW STE 320A
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-2112
Practice Address - Country:US
Practice Address - Phone:202-541-9844
Practice Address - Fax:202-541-9845
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN1005309164W00000X
DC1052512163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse