Provider Demographics
NPI:1083452585
Name:EWANG, MABEL EBOTE
Entity type:Individual
Prefix:
First Name:MABEL
Middle Name:EBOTE
Last Name:EWANG
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 1:9106 EDMONSTON CT
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-1553
Mailing Address - Country:US
Mailing Address - Phone:667-228-2296
Mailing Address - Fax:
Practice Address - Street 1:9106 EDMONSTON CT
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-1553
Practice Address - Country:US
Practice Address - Phone:667-228-2296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide