Provider Demographics
NPI:1073874426
Name:LUM-AZAH, WINKLER BOMA (HHA)
Entity Type:Individual
Prefix:
First Name:WINKLER BOMA
Middle Name:
Last Name:LUM-AZAH
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4237 58TH AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-1936
Mailing Address - Country:US
Mailing Address - Phone:240-431-4852
Mailing Address - Fax:
Practice Address - Street 1:4237 58TH AVE APT 7
Practice Address - Street 2:
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-1936
Practice Address - Country:US
Practice Address - Phone:240-431-4852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide