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General NPI Number Information
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NPI Number | 1548818750
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Entity Type | Individual
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Provider Name | MR. BONAVENTURE MBELLA
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Gender | Male
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Dates
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Enumeration Date | 08/30/2019
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 12513 WOODSONG LN
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City | BOWIE
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State | MD
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Zip | 20721-4225
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Country | US
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Telephone | 256-417-7067
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Fax |
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Provider Business Mailing Address
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Address Line | 12513 WOODSONG LN
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City | BOWIE
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State | MD
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Zip | 20721-4225
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Country | US
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Telephone | 256-417-7067
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R196090
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | R196090
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | NP1019745
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License Number State | DC
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Taxonomy #4
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | NP1019745
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License Number State | DC
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Taxonomy #5
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | R196090
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License Number State | MD
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Taxonomy #6
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN1019745
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License Number State | DC
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