Provider Demographics
NPI:1417727769
Name:MBA, RENET ENGOWI
Entity Type:Individual
Prefix:
First Name:RENET ENGOWI
Middle Name:
Last Name:MBA
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 1:3400 DEAN DR APT 204
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-1201
Mailing Address - Country:US
Mailing Address - Phone:202-923-1646
Mailing Address - Fax:
Practice Address - Street 1:3400 DEAN DR APT 204
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-1201
Practice Address - Country:US
Practice Address - Phone:202-923-1646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide