Healthcare Provider Details

I. General information

NPI: 1033819925
Provider Name (Legal Business Name): ABISHAG NADDULI BUKIRWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2023
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 TAYLOR ST NW
WASHINGTON DC
20011-5617
US

IV. Provider business mailing address

2005 TOWN CENTER BLVD UNIT 4769
ODENTON MD
21113-1785
US

V. Phone/Fax

Practice location:
  • Phone: 202-464-9200
  • Fax:
Mailing address:
  • Phone: 857-399-3408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: