Provider Demographics
NPI:1578823068
Name:MUKUM, VERONICA ATUH
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:ATUH
Last Name:MUKUM
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 1:12223 GUINEVERE RD
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-8937
Mailing Address - Country:US
Mailing Address - Phone:240-505-2166
Mailing Address - Fax:
Practice Address - Street 1:1810 METZEROTT RD
Practice Address - Street 2:APT 42
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-5146
Practice Address - Country:US
Practice Address - Phone:240-505-2166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN1006661164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse