Healthcare Provider Details

I. General information

NPI: 1205603552
Provider Name (Legal Business Name): MAUREEN MUTUA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2023
Last Update Date: 12/07/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 K ST NE
WASHINGTON DC
20002-4216
US

IV. Provider business mailing address

35 K ST NE
WASHINGTON DC
20002-4216
US

V. Phone/Fax

Practice location:
  • Phone: 202-978-2857
  • Fax:
Mailing address:
  • Phone: 240-476-4787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN500012843
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: