Provider Demographics
NPI:1952943037
Name:EFOBI, CLEMENT MBANEFO (APRN)
Entity type:Individual
Prefix:
First Name:CLEMENT
Middle Name:MBANEFO
Last Name:EFOBI
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11304 SPRINGPARK CT
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9611
Mailing Address - Country:US
Mailing Address - Phone:301-464-3787
Mailing Address - Fax:
Practice Address - Street 1:810 5TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-2622
Practice Address - Country:US
Practice Address - Phone:202-733-5378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-10
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
MDR240326363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator