Provider Demographics
NPI:1902326168
Name:EGBE, ENOWTABONG BENJAMIN (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:ENOWTABONG
Middle Name:BENJAMIN
Last Name:EGBE
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 CASLON WAY APT 101
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-5984
Mailing Address - Country:US
Mailing Address - Phone:301-996-7422
Mailing Address - Fax:
Practice Address - Street 1:1100 NEW JERSEY AVE SE STE 845
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-3302
Practice Address - Country:US
Practice Address - Phone:202-545-6980
Practice Address - Fax:877-839-6747
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNSA-0016251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health