Provider Demographics
NPI:1770203267
Name:TANGIRI DIVINE, TAMBE
Entity type:Individual
Prefix:
First Name:TAMBE
Middle Name:
Last Name:TANGIRI DIVINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9643 MUIRKIRK RD APT A162
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-2601
Mailing Address - Country:US
Mailing Address - Phone:202-390-6765
Mailing Address - Fax:
Practice Address - Street 1:9643 MUIRKIRK RD APT A162
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-2601
Practice Address - Country:US
Practice Address - Phone:202-390-6765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-02
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide