Provider Demographics
NPI:1124840137
Name:MBINGLO, MACSELINE
Entity type:Individual
Prefix:
First Name:MACSELINE
Middle Name:
Last Name:MBINGLO
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 1:3182 ROESCH BLVD APT 4
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-7035
Mailing Address - Country:US
Mailing Address - Phone:262-302-0415
Mailing Address - Fax:
Practice Address - Street 1:3182 ROESCH BLVD APT 4
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-7035
Practice Address - Country:US
Practice Address - Phone:262-330-2041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VU231768172A00000X
OH324968000624253Z00000X, 374U00000X
376J00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No172A00000XOther Service ProvidersDriver
No253Z00000XAgenciesIn Home Supportive Care
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker