Provider Demographics
NPI:1467934703
Name:MELANIE, MBWANG
Entity Type:Individual
Prefix:MRS
First Name:MBWANG
Middle Name:
Last Name:MELANIE
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 1:7001 96TH AVE
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3615
Mailing Address - Country:US
Mailing Address - Phone:240-595-9631
Mailing Address - Fax:202-388-4230
Practice Address - Street 1:7001 96TH AVE
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3615
Practice Address - Country:US
Practice Address - Phone:240-595-9631
Practice Address - Fax:202-388-4230
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13938374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide