Healthcare Provider Details

I. General information

NPI: 1477814291
Provider Name (Legal Business Name): EVELYNE NGWAMAFONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9757 GOOD LUCK RD APT 6
LANHAM MD
20706-3327
US

IV. Provider business mailing address

9757 GOOD LUCK RD APT 6
LANHAM MD
20706-3327
US

V. Phone/Fax

Practice location:
  • Phone: 301-523-9994
  • Fax:
Mailing address:
  • Phone: 301-523-9994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN500023692
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: