Provider Demographics
NPI:1396420147
Name:MAKA, EVA V
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:V
Last Name:MAKA
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 1:7815 MANDAN RD APT 203
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2140
Mailing Address - Country:US
Mailing Address - Phone:240-605-3184
Mailing Address - Fax:
Practice Address - Street 1:7815 MANDAN RD
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2140
Practice Address - Country:US
Practice Address - Phone:240-605-3184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN200002577164W00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse