Provider Demographics
NPI:1477814291
Name:NGWAMAFONG, EVELYNE
Entity Type:Individual
Prefix:
First Name:EVELYNE
Middle Name:
Last Name:NGWAMAFONG
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 1:9757 GOOD LUCK RD APT 6
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3327
Mailing Address - Country:US
Mailing Address - Phone:301-523-9994
Mailing Address - Fax:
Practice Address - Street 1:9757 GOOD LUCK RD APT 6
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3327
Practice Address - Country:US
Practice Address - Phone:301-523-9994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide