Provider Demographics
NPI:1316726649
Name:TEBEDO, ANNELIESE MARIE (FNP-C)
Entity type:Individual
Prefix:
First Name:ANNELIESE
Middle Name:MARIE
Last Name:TEBEDO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ANNELIESE
Other - Middle Name:MARIE
Other - Last Name:CASEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:149 LOGAN CT STE B
Mailing Address - Street 2:
Mailing Address - City:ANGIER
Mailing Address - State:NC
Mailing Address - Zip Code:27501-8579
Mailing Address - Country:US
Mailing Address - Phone:910-292-9576
Mailing Address - Fax:
Practice Address - Street 1:149 LOGAN CT STE B
Practice Address - Street 2:
Practice Address - City:ANGIER
Practice Address - State:NC
Practice Address - Zip Code:27501-8579
Practice Address - Country:US
Practice Address - Phone:910-292-9576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5018742363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner