Provider Demographics
NPI:1629555354
Name:MBALEWE, EZINNA ULOMA (RN)
Entity Type:Individual
Prefix:
First Name:EZINNA
Middle Name:ULOMA
Last Name:MBALEWE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3140 BEETHOVEN WAY
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-6860
Mailing Address - Country:US
Mailing Address - Phone:301-661-8365
Mailing Address - Fax:
Practice Address - Street 1:14725 GOOD HOPE RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20905-6020
Practice Address - Country:US
Practice Address - Phone:240-970-5310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR139466171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
1730666546OtherNATIONAL PROVIDER ID