MEDICARE: DR. EDWIN O JUMA CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0200X	Critical Care Medicine Registered Nurse	R206363	MN
2	363LG0600X	Gerontology Nurse Practitioner	AG07190058	MD
3	363LA2200X	Adult Health Nurse Practitioner	AG07190058	MD

General Provider Information

NPI Number	:	1134781875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWIN O JUMA CRNP

Provider Business Mailing Address
First Line	:	303 CHERRYSTONE CT
Second Line	:
City	:	REISTERSTOWN
State	:	MD
Zip	:	21136-6211
Country	:	US
Telephone Number	:	757-667-9549
Fax Number	:	410-670-5075

Provider Business Practice Location Address
First Line	:	303 CHERRYSTONE CT
Second Line	:
City	:	REISTERSTOWN
State	:	MD
Zip	:	21136-6211
Country	:	US
Telephone Number	:	410-670-5065
Fax Number	:	410-670-5075

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2019
Last Update Date	:	03/13/2026

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