Healthcare Provider Details

I. General information

NPI: 1356010987
Provider Name (Legal Business Name): FUNGISAI JULIET MARUMAHOKO BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 09/08/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E GUDE DR
ROCKVILLE MD
20850-5307
US

IV. Provider business mailing address

5011 JEFFREY DR
MOUNT AIRY MD
21771-8927
US

V. Phone/Fax

Practice location:
  • Phone: 240-777-1684
  • Fax:
Mailing address:
  • Phone: 301-461-4814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR204436
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: