Provider Demographics
NPI:1679259238
Name:NJUALEM, RACHEAL MBENGAWE
Entity type:Individual
Prefix:
First Name:RACHEAL
Middle Name:MBENGAWE
Last Name:NJUALEM
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 1:2 MANDOLIN CT
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-5336
Mailing Address - Country:US
Mailing Address - Phone:302-252-8245
Mailing Address - Fax:
Practice Address - Street 1:2 MANDOLIN CT
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5336
Practice Address - Country:US
Practice Address - Phone:302-252-8245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0052922164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty