Provider Demographics
NPI:1447726385
Name:MBAH, EDELQUEEN AWOH (HOME HEALTH AIDE)
Entity type:Individual
Prefix:
First Name:EDELQUEEN
Middle Name:AWOH
Last Name:MBAH
Suffix:
Gender:F
Credentials:HOME HEALTH AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 BENNING RD NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-7211
Mailing Address - Country:US
Mailing Address - Phone:202-239-2666
Mailing Address - Fax:
Practice Address - Street 1:1809 BENNING RD NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-7211
Practice Address - Country:US
Practice Address - Phone:202-239-2666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14060374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide