MEDICARE: VERA TANJONG-ONUMAJURU NP

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	363LF0000X	Family Nurse Practitioner	R220405	MD
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R220405	MD
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN1037548	DC

General Provider Information

NPI Number	:	1598316796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERA TANJONG-ONUMAJURU NP

Provider Business Mailing Address
First Line	:	4301 NORTHVIEW DR
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20716-2600
Country	:	US
Telephone Number	:	240-554-7792
Fax Number	:	877-775-6657

Provider Business Practice Location Address
First Line	:	4301 NORTHVIEW DR
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20716-2600
Country	:	US
Telephone Number	:	240-554-7792
Fax Number	:

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

Provider Enumeration Date	:	09/28/2019
Last Update Date	:	11/12/2025

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