Healthcare Provider Details

I. General information

NPI: 1669735643
Provider Name (Legal Business Name): ANDAM BUMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2012
Last Update Date: 06/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7826 EASTERN AVE NW LL18A
WASHINGTON DC
20012-1324
US

IV. Provider business mailing address

7826 EASTERN AVE NW LL18A
WASHINGTON DC
20012-1324
US

V. Phone/Fax

Practice location:
  • Phone: 202-722-7776
  • Fax: 202-722-7785
Mailing address:
  • Phone: 202-722-7776
  • Fax: 202-722-7785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1016005
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: