Provider Demographics
NPI:1033993951
Name:TUMALIUAN, BUENA MAE MALAKI
Entity Type:Individual
Prefix:
First Name:BUENA MAE
Middle Name:MALAKI
Last Name:TUMALIUAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BUENA MAE
Other - Middle Name:MALABAD
Other - Last Name:MALAKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9523 HALLHURST RD
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4820
Mailing Address - Country:US
Mailing Address - Phone:240-640-7601
Mailing Address - Fax:
Practice Address - Street 1:9523 HALLHURST RD
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-4820
Practice Address - Country:US
Practice Address - Phone:240-640-7601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR227010163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical