Provider Demographics
NPI:1831459643
Name:MBU, THERESIA AYANGNYOR
Entity Type:Individual
Prefix:MS
First Name:THERESIA
Middle Name:AYANGNYOR
Last Name:MBU
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 1:6010 SPRINGHILL DR
Mailing Address - Street 2:APT 101
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3104
Mailing Address - Country:US
Mailing Address - Phone:202-425-1431
Mailing Address - Fax:
Practice Address - Street 1:6010 SPRINGHILL DR
Practice Address - Street 2:APT 101
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3104
Practice Address - Country:US
Practice Address - Phone:202-425-1431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-26
Last Update Date:2012-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide