Provider Demographics
NPI:1649896036
Name:MEBANE, TINA ROCHELL
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:ROCHELL
Last Name:MEBANE
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:PO BOX 5016
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27435-0016
Mailing Address - Country:US
Mailing Address - Phone:336-456-2370
Mailing Address - Fax:
Practice Address - Street 1:1031 SUMMIT AVE STE S-4
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-7010
Practice Address - Country:US
Practice Address - Phone:336-456-2370
Practice Address - Fax:336-763-5065
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-22
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care