Provider Demographics
NPI:1497995286
Name:KUMOLALO, HELEN TINUKE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:HELEN
Middle Name:TINUKE
Last Name:KUMOLALO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 WEST BELVEDERE AVE
Mailing Address - Street 2:CARDIAC DIAGNOSTIC CENTER
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215
Mailing Address - Country:US
Mailing Address - Phone:410-601-8450
Mailing Address - Fax:
Practice Address - Street 1:5205 EAST DR STE H
Practice Address - Street 2:
Practice Address - City:ARBUTUS
Practice Address - State:MD
Practice Address - Zip Code:21227-2403
Practice Address - Country:US
Practice Address - Phone:443-631-4318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR143503363LA2100X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD032332200Medicaid
MD032332200Medicaid
MDS589Medicare PIN