Provider Demographics
NPI:1932882263
Name:AMBAN, LIZET ETOWBING
Entity Type:Individual
Prefix:
First Name:LIZET
Middle Name:ETOWBING
Last Name:AMBAN
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 1:5437 85TH AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4520
Mailing Address - Country:US
Mailing Address - Phone:571-427-8304
Mailing Address - Fax:
Practice Address - Street 1:5437 85TH AVE APT 202
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4520
Practice Address - Country:US
Practice Address - Phone:571-427-8304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide