Provider Demographics
NPI:1497229850
Name:MBAH, OLIVIA MBUANOBE (MSN NP)
Entity Type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:MBUANOBE
Last Name:MBAH
Suffix:
Gender:F
Credentials:MSN NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1705 E WEST HWY APT 314
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3061
Mailing Address - Country:US
Mailing Address - Phone:301-257-2314
Mailing Address - Fax:
Practice Address - Street 1:7500 HANOVER PKWY STE 202
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2009
Practice Address - Country:US
Practice Address - Phone:301-289-7722
Practice Address - Fax:301-441-2518
Is Sole Proprietor?:No
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR129347363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner