Provider Demographics
NPI:1255185567
Name:MBOKEH, ADELINE
Entity type:Individual
Prefix:
First Name:ADELINE
Middle Name:
Last Name:MBOKEH
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 1:2709 HOLLYWELL CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2999
Mailing Address - Country:US
Mailing Address - Phone:240-714-8561
Mailing Address - Fax:
Practice Address - Street 1:2709 HOLLYWELL CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-2999
Practice Address - Country:US
Practice Address - Phone:240-714-8561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator