Provider Demographics
NPI:1013277250
Name:MBAH, AIDNA A (LPN)
Entity Type:Individual
Prefix:MS
First Name:AIDNA
Middle Name:A
Last Name:MBAH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7333 NEW HAMPSHIRE AVE
Mailing Address - Street 2:APT 612
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6958
Mailing Address - Country:US
Mailing Address - Phone:240-464-5620
Mailing Address - Fax:
Practice Address - Street 1:7333 NEW HAMPSHIRE AVE
Practice Address - Street 2:APT 612
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6958
Practice Address - Country:US
Practice Address - Phone:240-464-5620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN1005620164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse