Provider Demographics
NPI:1649716275
Name:MBAH, ATUH JOAN
Entity type:Individual
Prefix:MR
First Name:ATUH
Middle Name:JOAN
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 1:2503 ALLISON ST
Mailing Address - Street 2:2
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712-1254
Mailing Address - Country:US
Mailing Address - Phone:301-658-8847
Mailing Address - Fax:
Practice Address - Street 1:1101 L ST NW
Practice Address - Street 2:204
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-4031
Practice Address - Country:US
Practice Address - Phone:202-808-2362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC12631374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide