Healthcare Provider Details

I. General information

NPI: 1508753971
Provider Name (Legal Business Name): HANSON MBAH NDUM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9969 GOOD LUCK RD APT 104
LANHAM MD
20706-3277
US

IV. Provider business mailing address

9969 GOOD LUCK RD
LANHAM MD
20706-3277
US

V. Phone/Fax

Practice location:
  • Phone: 240-615-7460
  • Fax:
Mailing address:
  • Phone: 240-615-7460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: