Provider Demographics
NPI:1992202212
Name:MBENWOH, SERAPHINE FORCHALEKE
Entity Type:Individual
Prefix:
First Name:SERAPHINE
Middle Name:FORCHALEKE
Last Name:MBENWOH
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 1:7737 RIVERDALE RD APT 304
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3904
Mailing Address - Country:US
Mailing Address - Phone:240-467-7399
Mailing Address - Fax:
Practice Address - Street 1:7737 RIVERDALE RD APT 304
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3904
Practice Address - Country:US
Practice Address - Phone:240-467-7399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-12
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13582374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide