Provider Demographics
NPI:1346712825
Name:NUBIGA, COLLINS
Entity Type:Individual
Prefix:
First Name:COLLINS
Middle Name:
Last Name:NUBIGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3817 64TH AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-1857
Mailing Address - Country:US
Mailing Address - Phone:240-714-2445
Mailing Address - Fax:
Practice Address - Street 1:3817 64TH AVE APT 101
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-1857
Practice Address - Country:US
Practice Address - Phone:240-714-2445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14217374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide