Provider Demographics
NPI:1972195196
Name:TIBUI, MERCY S
Entity Type:Individual
Prefix:
First Name:MERCY S
Middle Name:
Last Name:TIBUI
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 1:8106 GORMAN AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-3570
Mailing Address - Country:US
Mailing Address - Phone:240-593-5609
Mailing Address - Fax:
Practice Address - Street 1:8106 GORMAN AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-3570
Practice Address - Country:US
Practice Address - Phone:240-593-5609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide