Healthcare Provider Details

I. General information

NPI: 1316809106
Provider Name (Legal Business Name): HENRY K LUKWAGO MSN-AGPCNP RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 SENTINEL RIDGE LN
STAFFORD VA
22554-5662
US

IV. Provider business mailing address

155 SENTINEL RIDGE LN
STAFFORD VA
22554-5662
US

V. Phone/Fax

Practice location:
  • Phone: 240-547-7651
  • Fax: 540-720-1006
Mailing address:
  • Phone: 240-547-7651
  • Fax: 540-720-1006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number0001269525
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: