Provider Demographics
NPI:1851787725
Name:MBAH, STELLA EBERE (CRNP)
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:EBERE
Last Name:MBAH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4306 BROOKSIDE OAKS
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5169
Mailing Address - Country:US
Mailing Address - Phone:410-963-9577
Mailing Address - Fax:
Practice Address - Street 1:7131 LIBERTY RD STE 100
Practice Address - Street 2:
Practice Address - City:GWYNN OAK
Practice Address - State:MD
Practice Address - Zip Code:21207-4580
Practice Address - Country:US
Practice Address - Phone:410-963-9577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD363LF0000X363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily