Provider Demographics
NPI:1144904368
Name:EKA, JESSIE ETEYEN
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:ETEYEN
Last Name:EKA
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 1:1412 ELM GROVE CIR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-6059
Mailing Address - Country:US
Mailing Address - Phone:240-645-2401
Mailing Address - Fax:
Practice Address - Street 1:1412 ELM GROVE CIR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20905-6059
Practice Address - Country:US
Practice Address - Phone:240-645-2401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-09
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator