Healthcare Provider Details

I. General information

NPI: 1780523019
Provider Name (Legal Business Name): IDA LOSENJA LUMA HADDISON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7721 DIGNITY WAY
SEVERN MD
21144-1197
US

IV. Provider business mailing address

7721 DIGNITY WAY
SEVERN MD
21144-1197
US

V. Phone/Fax

Practice location:
  • Phone: 202-677-9722
  • Fax:
Mailing address:
  • Phone: 202-677-9722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1038490
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: