Provider Demographics
NPI:1144744194
Name:EVINA, JEANNESE AKUMBA II
Entity Type:Individual
Prefix:MRS
First Name:JEANNESE
Middle Name:AKUMBA
Last Name:EVINA
Suffix:II
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 1:5024 SILVER HILL COURT
Mailing Address - Street 2:104
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747
Mailing Address - Country:US
Mailing Address - Phone:0561-358-2967
Mailing Address - Fax:
Practice Address - Street 1:5024 SILVER HILL CT
Practice Address - Street 2:
Practice Address - City:DISTRICT HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20747-2006
Practice Address - Country:US
Practice Address - Phone:056-135-8296
Practice Address - Fax:561-358-2967
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12935374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide