# IMMACULATE NGWE MBONY

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1043804990
- **Gender:** F
- **Credential:** APRN

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | AC007215 | MD | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 2289761 | MA | Yes |

## Other

- **Enumeration date:** 02/22/2021
- **Last updated:** 02/04/2026