Provider Demographics
NPI:1952185357
Name:TEKO, CLOVIS TEKO
Entity Type:Individual
Prefix:
First Name:CLOVIS TEKO
Middle Name:
Last Name:TEKO
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 1:6001 LOGAN WAY APT C4
Mailing Address - Street 2:
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-1862
Mailing Address - Country:US
Mailing Address - Phone:240-495-9278
Mailing Address - Fax:
Practice Address - Street 1:6001 LOGAN WAY APT C4
Practice Address - Street 2:
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-1862
Practice Address - Country:US
Practice Address - Phone:240-495-9278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide