| Doctor Name: | MARY CATHERINE TEBO |
| NPI Number: | 1710312533 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN |
| License Number: | 5515 |
| Business Practice Address: | 1 Royce Cir Suite 104 Storrs, CT - 062682260 |
| Business Phone Number: | 8604879200 |
| Business Fax Number: | 8604879222 |
| Mailing Address: | 263 Farmington Ave, Provider Enrollment FARMINGTON |
| State: | CT |
| Postal Code: | 060302212 |
| Phone Number: | 8606797503 |
| Fax Number: | 8606791610 |
| NPI Enumeration Date: | 09/11/2013 |
| NPI Last Update Date: | 05/12/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 5515 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |