Provider Demographics
NPI:1093940595
Name:MBAH, CATHERINE N (RN)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:N
Last Name:MBAH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 TERRACEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-2457
Mailing Address - Country:US
Mailing Address - Phone:937-270-7826
Mailing Address - Fax:
Practice Address - Street 1:1019 TERRACEWOOD DR
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-2457
Practice Address - Country:US
Practice Address - Phone:937-270-7826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH321209163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse