Provider Demographics
NPI:1972378123
Name:JONATHAN, EVA
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:JONATHAN
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 1:12610 PRINCES CHOICE DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-3399
Mailing Address - Country:US
Mailing Address - Phone:301-683-4682
Mailing Address - Fax:
Practice Address - Street 1:12610 PRINCES CHOICE DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-3399
Practice Address - Country:US
Practice Address - Phone:301-683-4682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA200003241374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide