Provider Demographics
NPI:1659160521
Name:JOSEPHINE, NKENG TEBA
Entity type:Individual
Prefix:
First Name:NKENG
Middle Name:TEBA
Last Name:JOSEPHINE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 RIDGELY ST
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1928
Mailing Address - Country:US
Mailing Address - Phone:240-261-3904
Mailing Address - Fax:
Practice Address - Street 1:302 RIDGELY ST
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-1928
Practice Address - Country:US
Practice Address - Phone:240-261-3904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide