Provider Demographics
NPI:1548868847
Name:MBOWE, ANNAGRACE WILFRED
Entity type:Individual
Prefix:
First Name:ANNAGRACE
Middle Name:WILFRED
Last Name:MBOWE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21917 MANOR CREST LN
Mailing Address - Street 2:
Mailing Address - City:BOYDS
Mailing Address - State:MD
Mailing Address - Zip Code:20841-4122
Mailing Address - Country:US
Mailing Address - Phone:240-481-5919
Mailing Address - Fax:
Practice Address - Street 1:1434 4TH ST SW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-2204
Practice Address - Country:US
Practice Address - Phone:202-848-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty