Provider Demographics
NPI:1285026575
Name:MBAZANG, LANITA ENGWARI (HHA)
Entity Type:Individual
Prefix:MS
First Name:LANITA
Middle Name:ENGWARI
Last Name:MBAZANG
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:MS
Other - First Name:LANITA
Other - Middle Name:ENGWARI
Other - Last Name:MBAZANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HHA
Mailing Address - Street 1:5601 13TH ST NW APT 208
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-3562
Mailing Address - Country:US
Mailing Address - Phone:202-604-4935
Mailing Address - Fax:
Practice Address - Street 1:5601 13TH ST NW APT 208
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-3562
Practice Address - Country:US
Practice Address - Phone:202-604-4935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA9468374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCHHA102OtherHHA