Provider Demographics
NPI:1447868260
Name:MBONU, JULIET ERINMA (DNP, RN)
Entity type:Individual
Prefix:
First Name:JULIET
Middle Name:ERINMA
Last Name:MBONU
Suffix:
Gender:F
Credentials:DNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 EAGLES RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:BROOKEVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20833-1835
Mailing Address - Country:US
Mailing Address - Phone:301-640-6779
Mailing Address - Fax:
Practice Address - Street 1:1812 EAGLES RIDGE CT
Practice Address - Street 2:
Practice Address - City:BROOKEVILLE
Practice Address - State:MD
Practice Address - Zip Code:20833-1835
Practice Address - Country:US
Practice Address - Phone:301-640-6779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-17
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR114898163W00000X
DCRN200005977163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR114898OtherNURSING