Healthcare Provider Details

I. General information

NPI: 1740298579
Provider Name (Legal Business Name): IMMACULATA ULU CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IMMACULATA ULU NP

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4404 QUEENSBURY RD STE 210
RIVERDALE PARK MD
20737-1068
US

IV. Provider business mailing address

4404 QUEENSBURY RD STE 210
RIVERDALE PARK MD
20737-1068
US

V. Phone/Fax

Practice location:
  • Phone: 301-693-0501
  • Fax: 240-582-1393
Mailing address:
  • Phone: 301-693-0501
  • Fax: 240-582-1393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR107244
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR107244
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: