Provider Demographics
NPI:1437411303
Name:BOUMA, JUDITH KAH
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:KAH
Last Name:BOUMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 IRWIN ST
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1746
Mailing Address - Country:US
Mailing Address - Phone:202-560-2794
Mailing Address - Fax:
Practice Address - Street 1:315 IRWIN ST
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-1746
Practice Address - Country:US
Practice Address - Phone:202-560-2794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No172V00000XOther Service ProvidersCommunity Health Worker