Provider Demographics
NPI:1912277781
Name:MBETAZI, ALEMNGEH COLUMBUS (CRNP-BC)
Entity type:Individual
Prefix:
First Name:ALEMNGEH
Middle Name:COLUMBUS
Last Name:MBETAZI
Suffix:
Gender:M
Credentials:CRNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5010 REGENCY PL STE 203
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-3088
Mailing Address - Country:US
Mailing Address - Phone:240-427-3554
Mailing Address - Fax:240-419-2556
Practice Address - Street 1:5010 REGENCY PL STE 203
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3088
Practice Address - Country:US
Practice Address - Phone:240-427-3554
Practice Address - Fax:240-419-2556
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
MDR2004752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No374U00000XNursing Service Related ProvidersHome Health Aide