Provider Demographics
NPI:1730565599
Name:NDIKA, ELIZABETH EBEI (CRNP/ FNP-C, PMHNP-)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:EBEI
Last Name:NDIKA
Suffix:
Gender:F
Credentials:CRNP/ FNP-C, PMHNP-
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:EBEI
Other - Last Name:ACHENG-NDIKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ELIZABETH EBEI NDIKA
Mailing Address - Street 1:14333 LAUREL BOWIE RD STE 204
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-1179
Mailing Address - Country:US
Mailing Address - Phone:240-241-4989
Mailing Address - Fax:301-477-1976
Practice Address - Street 1:14333 LAUREL BOWIE RD STE 204
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-1179
Practice Address - Country:US
Practice Address - Phone:240-241-4989
Practice Address - Fax:301-477-1976
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-04
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR151225363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD666184000Medicaid