Provider Demographics
NPI:1861735631
Name:NDE, EVODIA MAMBO (HHA)
Entity type:Individual
Prefix:
First Name:EVODIA
Middle Name:MAMBO
Last Name:NDE
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13838 CASTLE BLVD APT 201
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7381
Mailing Address - Country:US
Mailing Address - Phone:434-378-0160
Mailing Address - Fax:
Practice Address - Street 1:13838 CASTLE BLVD APT 201
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7381
Practice Address - Country:US
Practice Address - Phone:434-378-0160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-31
Last Update Date:2013-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker