Provider Demographics
NPI:1972346070
Name:TEBO, TRACEY AJOH
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:AJOH
Last Name:TEBO
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 1:1707 ARCOLA AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-2813
Mailing Address - Country:US
Mailing Address - Phone:240-481-2256
Mailing Address - Fax:
Practice Address - Street 1:1707 ARCOLA AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-2813
Practice Address - Country:US
Practice Address - Phone:240-481-2256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide