Provider Demographics
NPI:1154681864
Name:MBANYAM, ROSE AKWI
Entity type:Individual
Prefix:MISS
First Name:ROSE
Middle Name:AKWI
Last Name:MBANYAM
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 1:9967 GOOD LUCK RD
Mailing Address - Street 2:#104
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3276
Mailing Address - Country:US
Mailing Address - Phone:240-413-9398
Mailing Address - Fax:
Practice Address - Street 1:9967 GOOD LUCK RD
Practice Address - Street 2:#104
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3276
Practice Address - Country:US
Practice Address - Phone:240-413-9398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker