Provider Demographics
NPI:1487490454
Name:ATEBA MVIENA, YANICK
Entity type:Individual
Prefix:
First Name:YANICK
Middle Name:
Last Name:ATEBA MVIENA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3574 POWDER MILL RD
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3525
Mailing Address - Country:US
Mailing Address - Phone:240-491-1605
Mailing Address - Fax:
Practice Address - Street 1:3574 POWDER MILL RD
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3525
Practice Address - Country:US
Practice Address - Phone:240-491-1605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator