Provider Demographics
NPI:1245745926
Name:MBAH, MIRABEL TIMBEN
Entity Type:Individual
Prefix:
First Name:MIRABEL
Middle Name:TIMBEN
Last Name:MBAH
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 1:8623 ANNAPOLIS RD
Mailing Address - Street 2:APT 102
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784
Mailing Address - Country:US
Mailing Address - Phone:240-318-6520
Mailing Address - Fax:
Practice Address - Street 1:2010 RHODE ISLAND AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NORTH EAST
Practice Address - State:DC
Practice Address - Zip Code:20018
Practice Address - Country:US
Practice Address - Phone:240-318-6520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC12654374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide