Provider Demographics
NPI:1487289906
Name:EGBEH, MARY WUMMI
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:WUMMI
Last Name:EGBEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:WUMMI
Other - Last Name:JOSHUA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2056 INDIAN DR
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-6411
Mailing Address - Country:US
Mailing Address - Phone:856-899-8944
Mailing Address - Fax:
Practice Address - Street 1:2056 INDIAN DR
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361-6411
Practice Address - Country:US
Practice Address - Phone:856-899-8944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-04
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR216587163WG0000X
NJ26NJ15179300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice