Healthcare Provider Details

I. General information

NPI: 1598013245
Provider Name (Legal Business Name): LUCY KOROMA RN, MSN-BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 01/18/2026
Certification Date: 01/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12164 CENTRAL AVE STE 228
MITCHELLVILLE MD
20721-1903
US

IV. Provider business mailing address

1206 ASHLEIGH STATION CT
BOWIE MD
20721-6005
US

V. Phone/Fax

Practice location:
  • Phone: 240-838-8911
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR212944
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR212944
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: