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General NPI Number Information
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NPI Number | 1467785154
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Entity Type | Individual
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Provider Name | EVELYN KINYUY NGWA NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 09/11/2009
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Last Update Date | 03/22/2022
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Provider Practice Location Address
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Address Line | 16 ROOSEVELT DRIVE
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City | LAUREL SPRINGS
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State | NJ
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Zip | 08021-2731
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Country | US
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Telephone | 856-232-6058
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Fax | 856-232-8260
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Provider Business Mailing Address
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Address Line | PO BOX 1897
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City | LAUREL SPRINGS
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State | NJ
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Zip | 08021-8897
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Country | US
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Telephone | 856-232-6058
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Fax | 856-232-8260
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 26NO12420700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 364SF0001X
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Taxonomy Name | Family Health Clinical Nurse Specialist
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License Number | 26NJ000261200
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 26NJ00261200
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License Number State | NJ
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