Healthcare Provider Details

I. General information

NPI: 1942540083
Provider Name (Legal Business Name): LUM MERCY MAXIMUANGU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2013
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11303 AMHERST AVE
SILVER SPRING MD
20902-4600
US

IV. Provider business mailing address

11303 AMHERST AVE STE 2
SILVER SPRING MD
20902-4600
US

V. Phone/Fax

Practice location:
  • Phone: 240-604-2949
  • Fax: 410-609-5551
Mailing address:
  • Phone: 240-604-2949
  • Fax: 410-609-5551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0000123
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR150156
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: