1043798390 NPI number — FNU NDUM SENDELA TIMBEN EPSE TEB

Table of content: FNU NDUM SENDELA TIMBEN EPSE TEB (NPI 1043798390)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043798390 NPI number — FNU NDUM SENDELA TIMBEN EPSE TEB

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NDUM SENDELA TIMBEN EPSE TEB
Provider First Name:
FNU
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NDUM SENDELA TIMBEN EPSE TEB
Provider Other First Name:
FNU
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1043798390
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2512 24TH ST NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20018-2126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-832-8340
Provider Business Mailing Address Fax Number:
202-832-8341

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1511 FRANKLIN ST NE APT 510
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20018-2054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-906-1284
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/30/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 374U00000X , with the licence number:  HHA13831 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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