Provider Demographics
NPI:1548841588
Name:MUNU, MBALU
Entity type:Individual
Prefix:
First Name:MBALU
Middle Name:
Last Name:MUNU
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 1:8480 IMPERIAL DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-1836
Mailing Address - Country:US
Mailing Address - Phone:240-264-7701
Mailing Address - Fax:410-946-2010
Practice Address - Street 1:8480 IMPERIAL DR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-1836
Practice Address - Country:US
Practice Address - Phone:240-264-7701
Practice Address - Fax:410-946-2010
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA15160376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide