Provider Demographics
NPI:1063948735
Name:MBELI, GLORY E
Entity type:Individual
Prefix:
First Name:GLORY
Middle Name:E
Last Name:MBELI
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 1:3302 CHAUNCEY PL
Mailing Address - Street 2:APT 101
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712-1005
Mailing Address - Country:US
Mailing Address - Phone:240-641-2726
Mailing Address - Fax:
Practice Address - Street 1:3302 CHAUNCEY PL
Practice Address - Street 2:APT 101
Practice Address - City:MOUNT RAINIER
Practice Address - State:MD
Practice Address - Zip Code:20712-1005
Practice Address - Country:US
Practice Address - Phone:240-641-2726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-02
Last Update Date:2018-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12571374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide