Provider Demographics
NPI:1598436172
Name:EBAMBE, YVETTE ABEITUGO
Entity type:Individual
Prefix:
First Name:YVETTE
Middle Name:ABEITUGO
Last Name:EBAMBE
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 1:3919 LAKEHOUSE RD APT 16
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3349
Mailing Address - Country:US
Mailing Address - Phone:202-940-3606
Mailing Address - Fax:
Practice Address - Street 1:3919 LAKEHOUSE RD APT 16
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3349
Practice Address - Country:US
Practice Address - Phone:202-940-3606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00193788374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide