Provider Demographics
NPI:1699464883
Name:KWEYILA, ADELLA NJINDANGAM
Entity type:Individual
Prefix:
First Name:ADELLA
Middle Name:NJINDANGAM
Last Name:KWEYILA
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 1:5910 UPPER CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-5407
Mailing Address - Country:US
Mailing Address - Phone:817-675-3358
Mailing Address - Fax:
Practice Address - Street 1:5910 UPPER CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-5407
Practice Address - Country:US
Practice Address - Phone:817-675-3358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR211787363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health