Provider Demographics
NPI:1467785154
Name:NGWA, EVELYN KINYUY (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:KINYUY
Last Name:NGWA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1897
Mailing Address - Street 2:
Mailing Address - City:LAUREL SPRINGS
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-8897
Mailing Address - Country:US
Mailing Address - Phone:856-232-6058
Mailing Address - Fax:856-232-8260
Practice Address - Street 1:16 ROOSEVELT DRIVE
Practice Address - Street 2:
Practice Address - City:LAUREL SPRINGS
Practice Address - State:NJ
Practice Address - Zip Code:08021-2731
Practice Address - Country:US
Practice Address - Phone:856-232-6058
Practice Address - Fax:856-232-8260
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NO12420700163WG0000X
NJ26NJ000261200364SF0001X
NJ26NJ00261200363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health