Provider Demographics
NPI:1811700495
Name:ETA, JUDITH TIMBUI
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:TIMBUI
Last Name:ETA
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 1:4301 QUANDERS PROMISE DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4694
Mailing Address - Country:US
Mailing Address - Phone:571-505-0758
Mailing Address - Fax:
Practice Address - Street 1:4301 QUANDERS PROMISE DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-4694
Practice Address - Country:US
Practice Address - Phone:571-505-0758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR230955363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health