Provider Demographics
NPI:1578395281
Name:MUA, BLANDINE ENZI
Entity type:Individual
Prefix:
First Name:BLANDINE
Middle Name:ENZI
Last Name:MUA
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 1:3105 QUEENS CHAPEL RD # APOT.101
Mailing Address - Street 2:
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712-1153
Mailing Address - Country:US
Mailing Address - Phone:240-398-7101
Mailing Address - Fax:
Practice Address - Street 1:3105 QUEENS CHAPEL RD # APOT.101
Practice Address - Street 2:
Practice Address - City:MOUNT RAINIER
Practice Address - State:MD
Practice Address - Zip Code:20712-1153
Practice Address - Country:US
Practice Address - Phone:240-398-7101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide