Provider Demographics
NPI:1639855299
Name:MGBENDI, OSITA (DNP- PMHNP)
Entity Type:Individual
Prefix:
First Name:OSITA
Middle Name:
Last Name:MGBENDI
Suffix:
Gender:M
Credentials:DNP- PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 PALISADES CIR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS PARK
Mailing Address - State:VA
Mailing Address - Zip Code:20111-8055
Mailing Address - Country:US
Mailing Address - Phone:973-610-1334
Mailing Address - Fax:
Practice Address - Street 1:1000 PALISADES CIR
Practice Address - Street 2:
Practice Address - City:MANASSAS PARK
Practice Address - State:VA
Practice Address - Zip Code:20111-8055
Practice Address - Country:US
Practice Address - Phone:973-610-1334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024187411363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health