Healthcare Provider Details

I. General information

NPI: 1275055592
Provider Name (Legal Business Name): ELIZABETH NABUKENYA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14207 GREENVIEW DR
LAUREL MD
20708-3215
US

IV. Provider business mailing address

14207 GREENVIEW DRIVE
LAUREL MD
20708
US

V. Phone/Fax

Practice location:
  • Phone: 301-758-4628
  • Fax:
Mailing address:
  • Phone: 301-758-4628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN1008280
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: