Healthcare Provider Details

I. General information

NPI: 1134781875
Provider Name (Legal Business Name): EDWIN O JUMA CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 CHERRYSTONE CT
REISTERSTOWN MD
21136-6211
US

IV. Provider business mailing address

303 CHERRYSTONE CT
REISTERSTOWN MD
21136-6211
US

V. Phone/Fax

Practice location:
  • Phone: 410-670-5065
  • Fax: 410-670-5075
Mailing address:
  • Phone: 757-667-9549
  • Fax: 410-670-5075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAG07190058
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAG07190058
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberR206363
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: