Provider Demographics
NPI:1285176313
Name:MBEA, ANATOLE
Entity type:Individual
Prefix:
First Name:ANATOLE
Middle Name:
Last Name:MBEA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6939 GEORGIA AVE NW
Mailing Address - Street 2:APT 301
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-2456
Mailing Address - Country:US
Mailing Address - Phone:240-449-6034
Mailing Address - Fax:
Practice Address - Street 1:6939 GEORGIA AVE NW
Practice Address - Street 2:APT 301
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-2456
Practice Address - Country:US
Practice Address - Phone:240-449-6034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11943374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide