Healthcare Provider Details

I. General information

NPI: 1578238945
Provider Name (Legal Business Name): EVANGELINE NYENPELU DOBLAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2021
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9324 BANDERA ST
LANHAM MD
20706-2411
US

IV. Provider business mailing address

9324 BANDERA ST
LANHAM MD
20706-2411
US

V. Phone/Fax

Practice location:
  • Phone: 240-714-8059
  • Fax:
Mailing address:
  • Phone: 240-714-8059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: