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General NPI Number Information
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NPI Number | 1396539987
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Entity Type | Organization
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Legal Business Name | KWANZA CLINIC LLC
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Dates
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Enumeration Date | 04/08/2025
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 303 CHERRYSTONE CT
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City | REISTERSTOWN
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State | MD
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Zip | 21136-6211
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Country | US
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Telephone | 757-667-9549
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Fax | 410-834-5631
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Provider Business Mailing Address
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Address Line | 303 CHERRYSTONE CT
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City | REISTERSTOWN
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State | MD
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Zip | 21136-6211
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Country | US
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Telephone | 757-667-9549
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Fax | 410-834-5631
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Authorized Official
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Title or Position | CRNP
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Name | DR. EDWIN JUMA
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Credential | DNP, CRNP
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Telephone | 757-667-9549
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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