Provider Demographics
NPI:1770126336
Name:NTUM, EVELYN MAMBO
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:MAMBO
Last Name:NTUM
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 1:1924 MERRIMAC DR
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-2202
Mailing Address - Country:US
Mailing Address - Phone:240-241-3319
Mailing Address - Fax:
Practice Address - Street 1:1924 MERRIMAC DR
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-2202
Practice Address - Country:US
Practice Address - Phone:240-241-3319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14698374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide