Provider Demographics
NPI:1780317727
Name:TATABOD, JUDE TIMAH (RN)
Entity type:Individual
Prefix:
First Name:JUDE
Middle Name:TIMAH
Last Name:TATABOD
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 VERNON ST NW # 1022
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-1217
Mailing Address - Country:US
Mailing Address - Phone:508-345-0973
Mailing Address - Fax:
Practice Address - Street 1:1802 VERNON ST NW # 1022
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-1217
Practice Address - Country:US
Practice Address - Phone:508-345-0973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1046789163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse