Provider Demographics
NPI:1043951163
Name:EBAN, LOVETH AYIAMA (PMHNP)
Entity type:Individual
Prefix:
First Name:LOVETH
Middle Name:AYIAMA
Last Name:EBAN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 ESPERANZA CT
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-2883
Mailing Address - Country:US
Mailing Address - Phone:443-610-4965
Mailing Address - Fax:
Practice Address - Street 1:1826 WOODLAWN DR STE 3&4
Practice Address - Street 2:
Practice Address - City:WOODLAWN
Practice Address - State:MD
Practice Address - Zip Code:21207-4050
Practice Address - Country:US
Practice Address - Phone:410-800-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR176648363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty