Provider Demographics
NPI:1962879395
Name:MBAH, OPHILIA N X (CRNP)
Entity type:Individual
Prefix:
First Name:OPHILIA
Middle Name:N
Last Name:MBAH
Suffix:X
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:OPHILIA
Other - Middle Name:N
Other - Last Name:TOH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4703 OLD SOPER RD
Mailing Address - Street 2:SUITE R-1
Mailing Address - City:CAMP SPRINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20746
Mailing Address - Country:US
Mailing Address - Phone:240-249-0989
Mailing Address - Fax:
Practice Address - Street 1:6856 EASTERN AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012
Practice Address - Country:US
Practice Address - Phone:202-545-6980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-02
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1028515163W00000X
MDR205445363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse