Provider Demographics
NPI:1538687140
Name:E & T HEALTHCARE ENTERPRISE
Entity Type:Organization
Organization Name:E & T HEALTHCARE ENTERPRISE
Other - Org Name:E & T HEALTHCARE ENTERPRISE
Other - Org Type:Other Name
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MISS
Authorized Official - First Name:EVELINE
Authorized Official - Middle Name:NTUI
Authorized Official - Last Name:TAKANG
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:240-264-9698
Mailing Address - Street 1:12904 NORTHAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705
Mailing Address - Country:US
Mailing Address - Phone:240-264-9698
Mailing Address - Fax:
Practice Address - Street 1:8113 HARTFORD ROAD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234
Practice Address - Country:US
Practice Address - Phone:410-882-4800
Practice Address - Fax:410-882-6667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-04
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR167174363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty