Provider Demographics
NPI:1497014013
Name:MBAH, EMERENCIA E (PMHNP)
Entity type:Individual
Prefix:MS
First Name:EMERENCIA
Middle Name:E
Last Name:MBAH
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:MS
Other - First Name:EMERENCIA
Other - Middle Name:E
Other - Last Name:MBAH EPSE MBAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP
Mailing Address - Street 1:1039 BLADENSBURG RD NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-2922
Mailing Address - Country:US
Mailing Address - Phone:202-507-8139
Mailing Address - Fax:
Practice Address - Street 1:1039 BLADENSBURG RD NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-2922
Practice Address - Country:US
Practice Address - Phone:202-507-8413
Practice Address - Fax:202-507-8413
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2025-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNP1055158363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health