Provider Demographics
NPI:1477315778
Name:MBONUH, NGETLA (DNP, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:NGETLA
Middle Name:
Last Name:MBONUH
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3702 GUINEVERE TRCE
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-7766
Mailing Address - Country:US
Mailing Address - Phone:443-615-6840
Mailing Address - Fax:
Practice Address - Street 1:3702 GUINEVERE TRCE
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-7766
Practice Address - Country:US
Practice Address - Phone:443-615-6840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11026442363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health