Provider Demographics
NPI:1093326167
Name:MABO, FAITH EBANGHA (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:EBANGHA
Last Name:MABO
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:EBANGHA
Other - Middle Name:FAITH
Other - Last Name:MABO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN-CNP
Mailing Address - Street 1:6405 CLAIRFIELD ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-3520
Mailing Address - Country:US
Mailing Address - Phone:361-558-3614
Mailing Address - Fax:
Practice Address - Street 1:6405 CLAIRFIELD ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-3520
Practice Address - Country:US
Practice Address - Phone:361-558-3614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1008864363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily