Healthcare Provider Details

I. General information

NPI: 1053786533
Provider Name (Legal Business Name): VIRGINIA MBANWEI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2015
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 NEW YORK AVE NE
WASHINGTON DC
20002-1848
US

IV. Provider business mailing address

2811 PENNSYLVANIA AVE SE
WASHINGTON DC
20020-3865
US

V. Phone/Fax

Practice location:
  • Phone: 202-489-0615
  • Fax:
Mailing address:
  • Phone: 202-894-6811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: