Provider Demographics
NPI:1265277677
Name:URSLA EPSE MBAKA, NEH TIMA
Entity type:Individual
Prefix:
First Name:NEH TIMA
Middle Name:
Last Name:URSLA EPSE MBAKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6827 RIVERDALE RD APT A201
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-3863
Mailing Address - Country:US
Mailing Address - Phone:240-726-9004
Mailing Address - Fax:
Practice Address - Street 1:6827 RIVERDALE RD APT A201
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-3863
Practice Address - Country:US
Practice Address - Phone:240-726-9004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide