Healthcare Provider Details

I. General information

NPI: 1720348683
Provider Name (Legal Business Name): JOAN NZELLE EWANE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8915 WOODBURN CT
LANHAM MD
20706-3520
US

IV. Provider business mailing address

8915 WOODBURN CT
LANHAM MD
20706-3520
US

V. Phone/Fax

Practice location:
  • Phone: 240-646-6497
  • Fax:
Mailing address:
  • Phone: 240-646-6497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: