Provider Demographics
NPI:1245758523
Name:NDI, EVARISTUS KOBI (RN)
Entity Type:Individual
Prefix:
First Name:EVARISTUS
Middle Name:KOBI
Last Name:NDI
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3512 CHERRYVALE DR
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3837
Mailing Address - Country:US
Mailing Address - Phone:240-701-6588
Mailing Address - Fax:
Practice Address - Street 1:3512 CHERRYVALE DR
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3837
Practice Address - Country:US
Practice Address - Phone:240-701-6588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1017603163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty