Provider Demographics
NPI:1528765336
Name:NGO MBENG, CHRISTINE OLIVE
Entity type:Individual
Prefix:
First Name:CHRISTINE OLIVE
Middle Name:
Last Name:NGO MBENG
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 1:5017 COLUMBIA RD APT 302
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-5628
Mailing Address - Country:US
Mailing Address - Phone:240-470-9989
Mailing Address - Fax:
Practice Address - Street 1:5017 COLUMBIA RD APT 3025017
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-5626
Practice Address - Country:US
Practice Address - Phone:240-470-9989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00178613376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide