Provider Demographics
NPI:1629339494
Name:MBAH, NOELLA A
Entity Type:Individual
Prefix:
First Name:NOELLA
Middle Name:A
Last Name:MBAH
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 1:8664 PINEY BRANCH RD
Mailing Address - Street 2:APT 12
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-3959
Mailing Address - Country:US
Mailing Address - Phone:301-978-6699
Mailing Address - Fax:
Practice Address - Street 1:8664 PINEY BRANCH RD
Practice Address - Street 2:APT 12
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901
Practice Address - Country:US
Practice Address - Phone:301-978-6699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide