Provider Demographics
NPI:1942553664
Name:MBACHAM, AJIEKAI PERPETUA
Entity Type:Individual
Prefix:
First Name:AJIEKAI
Middle Name:PERPETUA
Last Name:MBACHAM
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 1:3216 TOLEDO PL APT 104
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-8120
Mailing Address - Country:US
Mailing Address - Phone:240-468-5330
Mailing Address - Fax:
Practice Address - Street 1:3216 TOLEDO PL APT 104
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-8120
Practice Address - Country:US
Practice Address - Phone:240-468-5330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide