Provider Demographics
NPI:1285099788
Name:MBONU, PATRICIA CHINYERE
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:CHINYERE
Last Name:MBONU
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 1:11910 TWINLAKES DR
Mailing Address - Street 2:APT. 15
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3187
Mailing Address - Country:US
Mailing Address - Phone:240-646-6284
Mailing Address - Fax:
Practice Address - Street 1:11910 TWINLAKES DR
Practice Address - Street 2:APT. 15
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3187
Practice Address - Country:US
Practice Address - Phone:240-646-6284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN967454164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse