Provider Demographics
NPI:1316623424
Name:EGBE EUNICE, MILDRED NINYING
Entity type:Individual
Prefix:
First Name:MILDRED NINYING
Middle Name:
Last Name:EGBE EUNICE
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 1:10443 JOHN GLENN ST
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2589
Mailing Address - Country:US
Mailing Address - Phone:681-427-3331
Mailing Address - Fax:
Practice Address - Street 1:10443 JOHN GLENN ST
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2589
Practice Address - Country:US
Practice Address - Phone:681-427-3331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health