Provider Demographics
NPI:1841007275
Name:MBELEKA, HARIET MBONGEH
Entity type:Individual
Prefix:
First Name:HARIET
Middle Name:MBONGEH
Last Name:MBELEKA
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 1:7405 WILLOW THORNE DR
Mailing Address - Street 2:
Mailing Address - City:KRUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76227-5577
Mailing Address - Country:US
Mailing Address - Phone:240-444-9359
Mailing Address - Fax:
Practice Address - Street 1:7405 WILLOW THORNE DR
Practice Address - Street 2:
Practice Address - City:KRUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:76227-5577
Practice Address - Country:US
Practice Address - Phone:240-444-9359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA151593163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse