Provider Demographics
NPI:1184479289
Name:MBAH, GLORY ENJEI
Entity type:Individual
Prefix:
First Name:GLORY
Middle Name:ENJEI
Last Name:MBAH
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 1:1835 24TH ST NE APT 204
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-1926
Mailing Address - Country:US
Mailing Address - Phone:301-974-7526
Mailing Address - Fax:
Practice Address - Street 1:1835 24TH ST NE APT 204
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-1926
Practice Address - Country:US
Practice Address - Phone:301-974-7526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide