Healthcare Provider Details

I. General information

NPI: 1811858251
Provider Name (Legal Business Name): LUCIENNE DJOUBA BONDIMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LUCIENNE KRAEMER DJOUBA NKOLE

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4909 OLD COURT RD
RANDALLSTOWN MD
21133-4628
US

IV. Provider business mailing address

4909 OLD COURT RD
RANDALLSTOWN MD
21133-4628
US

V. Phone/Fax

Practice location:
  • Phone: 443-278-3227
  • Fax:
Mailing address:
  • Phone: 443-278-3227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR214366
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: