Provider Demographics
NPI:1134937105
Name:MBOHWOH, RAISA BETANGA
Entity type:Individual
Prefix:
First Name:RAISA
Middle Name:BETANGA
Last Name:MBOHWOH
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 1:11238 HANNAH WAY
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1681
Mailing Address - Country:US
Mailing Address - Phone:865-309-3517
Mailing Address - Fax:
Practice Address - Street 1:11238 HANNAH WAY
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-1681
Practice Address - Country:US
Practice Address - Phone:865-309-3517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide