Provider Demographics
NPI:1669940482
Name:TEBECK, AKUM GERALDINE
Entity type:Individual
Prefix:
First Name:AKUM
Middle Name:GERALDINE
Last Name:TEBECK
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 1:11437 CHERRY HILL RD APT 101
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3640
Mailing Address - Country:US
Mailing Address - Phone:301-328-6980
Mailing Address - Fax:
Practice Address - Street 1:11437 CHERRY HILL RD APT 101
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3640
Practice Address - Country:US
Practice Address - Phone:301-328-6980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14066374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide