Provider Demographics
NPI:1558163808
Name:MBILACITY LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:MBILACITY LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER NP
Authorized Official - Prefix:
Authorized Official - First Name:CHINYERE
Authorized Official - Middle Name:
Authorized Official - Last Name:NWANESIDU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-943-5080
Mailing Address - Street 1:5 MCENELLY CIR
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-3672
Mailing Address - Country:US
Mailing Address - Phone:617-943-5080
Mailing Address - Fax:
Practice Address - Street 1:5 MCENELLY CIR
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-3672
Practice Address - Country:US
Practice Address - Phone:617-943-5080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty