Provider Demographics
NPI:1497925721
Name:MBENG, BRIDGET MBU (LPN)
Entity Type:Individual
Prefix:MISS
First Name:BRIDGET
Middle Name:MBU
Last Name:MBENG
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 VININGS WAY
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-7616
Mailing Address - Country:US
Mailing Address - Phone:716-903-8088
Mailing Address - Fax:
Practice Address - Street 1:1109 VININGS WAY
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-7616
Practice Address - Country:US
Practice Address - Phone:716-903-8088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL2-0009982164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse