Provider Demographics
NPI:1225432586
Name:KINTUM, EVELYN
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:
Last Name:KINTUM
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 1:221 LAKESIDE DR APT 102
Mailing Address - Street 2:APT 102
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2932
Mailing Address - Country:US
Mailing Address - Phone:202-740-5792
Mailing Address - Fax:
Practice Address - Street 1:221 LAKESIDE DR APT 102
Practice Address - Street 2:APT 102
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2932
Practice Address - Country:US
Practice Address - Phone:202-740-5792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA10258374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide