Provider Demographics
NPI:1952053936
Name:ACHUO, EBOT NSO THERESE
Entity Type:Individual
Prefix:
First Name:EBOT NSO THERESE
Middle Name:
Last Name:ACHUO
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 1:200 FORT MEADE RD APT 810
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4417
Mailing Address - Country:US
Mailing Address - Phone:240-360-8234
Mailing Address - Fax:
Practice Address - Street 1:200 FORT MEADE RD APT 810
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4417
Practice Address - Country:US
Practice Address - Phone:240-360-8234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide