Provider Demographics
NPI:1285058495
Name:TABU, NELSON NDAH (HHA CERTIFICATE)
Entity type:Individual
Prefix:MR
First Name:NELSON
Middle Name:NDAH
Last Name:TABU
Suffix:
Gender:M
Credentials:HHA CERTIFICATE
Other - Prefix:MR
Other - First Name:NELSON
Other - Middle Name:NDAH
Other - Last Name:TABU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HHA CERTIFICATE
Mailing Address - Street 1:3823 64TH AVE
Mailing Address - Street 2:APT#3
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784
Mailing Address - Country:US
Mailing Address - Phone:240-485-6014
Mailing Address - Fax:
Practice Address - Street 1:3823 64TH AVE
Practice Address - Street 2:APT 3
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784
Practice Address - Country:US
Practice Address - Phone:240-485-6014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA10293374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide