Provider Demographics
NPI:1487193066
Name:DORDAL-TURNER, EVA CHRISTINA
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:CHRISTINA
Last Name:DORDAL-TURNER
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 1:470 DEKALB AVE
Mailing Address - Street 2:APT #10E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-4448
Mailing Address - Country:US
Mailing Address - Phone:347-799-6153
Mailing Address - Fax:
Practice Address - Street 1:470 DEKALB AVE
Practice Address - Street 2:APT #10E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-4448
Practice Address - Country:US
Practice Address - Phone:347-799-6153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCERTIFICTION405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYXP38634FMedicaid