Basic Information
| Provider Information | |||||||||
| NPI: | 1659813483 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GWAABE | ||||||||
| FirstName: | EVELINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4906 WALLINGFORD PL | ||||||||
| Address2: | |||||||||
| City: | JEFFERSON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217558423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4433678686 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8 DELAY STREET | ||||||||
| Address2: | NIH, NHLBI/SICKLE CELL BRANCH, BLDG 10 | ||||||||
| City: | DANBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068108014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8603476971 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2016 | ||||||||
| LastUpdateDate: | 08/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | R178804 | MD | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LP0808X | 10832 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.