Provider Demographics
NPI:1033512041
Name:ENOW, MBENG (LPN)
Entity Type:Individual
Prefix:
First Name:MBENG
Middle Name:
Last Name:ENOW
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9332 EDMONSTON RD APT 203
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-4346
Mailing Address - Country:US
Mailing Address - Phone:240-705-2502
Mailing Address - Fax:
Practice Address - Street 1:9332 EDMONSTON RD APT 203
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-4346
Practice Address - Country:US
Practice Address - Phone:240-705-2502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN10074183747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant