Provider Demographics
NPI:1457947590
Name:EYIBA, NNENNA JOYCE (RN)
Entity Type:Individual
Prefix:
First Name:NNENNA
Middle Name:JOYCE
Last Name:EYIBA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15027 PINE TOP LN
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-1318
Mailing Address - Country:US
Mailing Address - Phone:240-486-4918
Mailing Address - Fax:
Practice Address - Street 1:15027 PINE TOP LN
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-1318
Practice Address - Country:US
Practice Address - Phone:240-486-4918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001282133163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health