Provider Demographics
NPI:1225627136
Name:DANIEL, KUMUTHA FLAWRENCE (NP)
Entity Type:Individual
Prefix:MRS
First Name:KUMUTHA
Middle Name:FLAWRENCE
Last Name:DANIEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 MERCANTILE LN STE 200H
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-4310
Mailing Address - Country:US
Mailing Address - Phone:301-957-5451
Mailing Address - Fax:
Practice Address - Street 1:1401 MERCANTILE LN STE 200H
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-4310
Practice Address - Country:US
Practice Address - Phone:301-957-5451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR187115363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health