Provider Demographics
NPI:1508657750
Name:MWANDU, MARCELA C
Entity type:Individual
Prefix:
First Name:MARCELA
Middle Name:C
Last Name:MWANDU
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 1:1500 WESTBRANCH DR APT 3101500
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3269
Mailing Address - Country:US
Mailing Address - Phone:240-435-9522
Mailing Address - Fax:240-435-9522
Practice Address - Street 1:1500 WESTBRANCH DR APT 3101500
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-3269
Practice Address - Country:US
Practice Address - Phone:240-435-9522
Practice Address - Fax:240-435-9522
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-16
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
MDLP56980164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No171M00000XOther Service ProvidersCase Manager/Care Coordinator