MEDICARE: EMMANUELA NICK MBAH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1073348843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMANUELA NICK MBAH

Provider Business Mailing Address
First Line	:	6439 PENNSYLVANIA AVE APT 201
Second Line	:
City	:	DISTRICT HEIGHTS
State	:	MD
Zip	:	20747-3023
Country	:	US
Telephone Number	:	240-838-0723
Fax Number	:

Provider Business Practice Location Address
First Line	:	6439 PENNSYLVANIA AVE APT 201
Second Line	:
City	:	DISTRICT HEIGHTS
State	:	MD
Zip	:	20747-3023
Country	:	US
Telephone Number	:	240-838-0723
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2024
Last Update Date	:	09/03/2024

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