Provider Demographics
NPI:1477304145
Name:MBENJA, PRECIOUS DIANGE
Entity Type:Individual
Prefix:
First Name:PRECIOUS
Middle Name:DIANGE
Last Name:MBENJA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13012 OLD STAGE COACH RD APT 3017
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-1626
Mailing Address - Country:US
Mailing Address - Phone:774-506-2045
Mailing Address - Fax:
Practice Address - Street 1:13012 OLD STAGE COACH RD APT 3017
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-1626
Practice Address - Country:US
Practice Address - Phone:774-506-2045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide