Healthcare Provider Details

I. General information

NPI: 1720341233
Provider Name (Legal Business Name): VERRA SIRRI MUBELE PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 12/15/2021
Certification Date: 12/14/2021
Deactivation Date: 11/23/2021
Reactivation Date: 12/10/2021

III. Provider practice location address

3849 BERLEIGH HILL CT
BURTONSVILLE MD
20866-1393
US

IV. Provider business mailing address

3849 BERLEIGH HILL CT
BURTONSVILLE MD
20866-1393
US

V. Phone/Fax

Practice location:
  • Phone: 240-383-7246
  • Fax:
Mailing address:
  • Phone: 240-384-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR195275
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN1023780
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: