Healthcare Provider Details

I. General information

NPI: 1487424586
Provider Name (Legal Business Name): TELMA NAAH MBANGAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2024
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14727 4TH ST UNIT 432
LAUREL MD
20707-3993
US

IV. Provider business mailing address

14727 4TH ST UNIT 432
LAUREL MD
20707-3993
US

V. Phone/Fax

Practice location:
  • Phone: 214-622-0681
  • Fax:
Mailing address:
  • Phone: 214-622-0681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: