Provider Demographics
NPI:1215518089
Name:MAKANY NDZANA, EVELYNE JEANNE (CRNP-PMH)
Entity type:Individual
Prefix:
First Name:EVELYNE
Middle Name:JEANNE
Last Name:MAKANY NDZANA
Suffix:
Gender:F
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5516 TRACEY BRUCE DR
Mailing Address - Street 2:
Mailing Address - City:ADAMSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21710-8914
Mailing Address - Country:US
Mailing Address - Phone:667-275-1445
Mailing Address - Fax:
Practice Address - Street 1:5516 TRACEY BRUCE DR
Practice Address - Street 2:
Practice Address - City:ADAMSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21710-8914
Practice Address - Country:US
Practice Address - Phone:667-275-1445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD212540363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty