Provider Demographics
NPI:1063905628
Name:ENGTAMBA, ROSE LEBA
Entity type:Individual
Prefix:
First Name:ROSE LEBA
Middle Name:
Last Name:ENGTAMBA
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 1:2413 21ST PL NE APT 1
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-1332
Mailing Address - Country:US
Mailing Address - Phone:443-360-7222
Mailing Address - Fax:
Practice Address - Street 1:2413 21ST PL NE APT 1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-1332
Practice Address - Country:US
Practice Address - Phone:443-360-7222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty