Provider Demographics
NPI:1417218454
Name:MBONGWE, BEATRICE ESUNG
Entity Type:Individual
Prefix:
First Name:BEATRICE
Middle Name:ESUNG
Last Name:MBONGWE
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 1:6411 LANDOVER RD
Mailing Address - Street 2:APT#202
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785
Mailing Address - Country:US
Mailing Address - Phone:240-604-0049
Mailing Address - Fax:
Practice Address - Street 1:6411 LANDOVER RD
Practice Address - Street 2:APT#202
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1407
Practice Address - Country:US
Practice Address - Phone:240-604-0049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM-152-085-235-883374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide