Provider Demographics
NPI:1710514542
Name:NEBAFU, GLADYS MBAH (PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:GLADYS
Middle Name:MBAH
Last Name:NEBAFU
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 GLENN DALE RD
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9211
Mailing Address - Country:US
Mailing Address - Phone:202-904-0462
Mailing Address - Fax:
Practice Address - Street 1:6100 GLENN DALE RD
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9211
Practice Address - Country:US
Practice Address - Phone:202-904-0462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1009565163WP0808X
MDR175384363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health