Provider Demographics
NPI:1457864654
Name:TAKULE, JUSTINE COSMAS (CPR/ FIRST AID)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:COSMAS
Last Name:TAKULE
Suffix:
Gender:M
Credentials:CPR/ FIRST AID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 QUEENS CHAPEL RD APT 103
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-3631
Mailing Address - Country:US
Mailing Address - Phone:240-899-0900
Mailing Address - Fax:
Practice Address - Street 1:2400 QUEENS CHAPEL RD APT 103
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-3631
Practice Address - Country:US
Practice Address - Phone:240-899-0900
Practice Address - Fax:240-899-0900
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide