MEDICARE: ENJECK RERIANE MBANWEI

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	171M00000X	Case Manager/Care Coordinator
2	374U00000X	Home Health Aide		DC

General Provider Information

NPI Number	:	1487422739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ENJECK RERIANE MBANWEI

Provider Business Mailing Address
First Line	:	8810 ENFIELD CT
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20708-2048
Country	:	US
Telephone Number	:	240-517-9706
Fax Number	:

Provider Business Practice Location Address
First Line	:	8810 ENFIELD CT
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20708-2048
Country	:	US
Telephone Number	:	240-517-9706
Fax Number	:

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

Provider Enumeration Date	:	12/15/2023
Last Update Date	:	06/12/2026

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