Provider Demographics
NPI:1558962506
Name:SULAIMAN, MEMUNA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:MEMUNA
Middle Name:
Last Name:SULAIMAN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10416 DEL RAY CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-4533
Mailing Address - Country:US
Mailing Address - Phone:301-537-2636
Mailing Address - Fax:301-537-2636
Practice Address - Street 1:10416 DEL RAY CT
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-4533
Practice Address - Country:US
Practice Address - Phone:301-537-2636
Practice Address - Fax:301-537-2636
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR153928363LP2300X
DCRN1057108163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care