MEDICARE: MS. LUCY KOROMA RN, MSN-BSN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	R212944	MD
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R212944	MD

General Provider Information

NPI Number	:	1598013245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LUCY KOROMA RN, MSN-BSN

Provider Business Mailing Address
First Line	:	1206 ASHLEIGH STATION CT
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20721-6005
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12164 CENTRAL AVE STE 228
Second Line	:
City	:	MITCHELLVILLE
State	:	MD
Zip	:	20721-1903
Country	:	US
Telephone Number	:	240-838-8911
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2012
Last Update Date	:	01/18/2026

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