Provider Demographics
NPI:1467187948
Name:MUKETE, DELLY BRIGHT
Entity Type:Individual
Prefix:
First Name:DELLY
Middle Name:BRIGHT
Last Name:MUKETE
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 1:11118 SUPERIOR LNDG
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-3491
Mailing Address - Country:US
Mailing Address - Phone:240-479-5931
Mailing Address - Fax:
Practice Address - Street 1:235 WELLESLEY ST
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493-1572
Practice Address - Country:US
Practice Address - Phone:781-768-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR210781163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical