Healthcare Provider Details

I. General information

NPI: 1962879395
Provider Name (Legal Business Name): OPHILIA N. MBAH X CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OPHILIA N. TOH

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 05/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6856 EASTERN AVE NW
WASHINGTON DC
20012
US

IV. Provider business mailing address

4703 OLD SOPER RD SUITE R-1
CAMP SPRINGS MD
20746
US

V. Phone/Fax

Practice location:
  • Phone: 202-545-6980
  • Fax:
Mailing address:
  • Phone: 240-249-0989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1028515
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR205445
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: