Provider Demographics
NPI:1144819806
Name:MBONG, JOSEPH ENONGENE (BSN, RN)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ENONGENE
Last Name:MBONG
Suffix:
Gender:M
Credentials:BSN, RN
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:MBONG
Other - Last Name:ENONGENE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:605 RED CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-2243
Mailing Address - Country:US
Mailing Address - Phone:240-421-4702
Mailing Address - Fax:
Practice Address - Street 1:4101 OLD NATIONAL PIKE
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-4115
Practice Address - Country:US
Practice Address - Phone:301-829-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR218959163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse