Basic Information
Provider Information | |||||||||
NPI: | 1902326168 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | EGBE | ||||||||
FirstName: | ENOWTABONG | ||||||||
MiddleName: | BENJAMIN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | REGISTERED NURSE | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1031 CASLON WAY APT 101 | ||||||||
Address2: |   | ||||||||
City: | HYATTSVILLE | ||||||||
State: | MD | ||||||||
PostalCode: | 207855984 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3019967422 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1100 NEW JERSEY AVE SE STE 845 | ||||||||
Address2: |   | ||||||||
City: | WASHINGTON | ||||||||
State: | DC | ||||||||
PostalCode: | 200033302 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2025456980 | ||||||||
FaxNumber: | 8778396747 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/20/2017 | ||||||||
LastUpdateDate: | 06/20/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | NSA-0016 | DC | Y |   | Agencies | Home Health |   |
No ID Information.