Provider Demographics
NPI:1831473628
Name:KISANGA, JOSEPH ERNEST (NP)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:ERNEST
Last Name:KISANGA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4234 LAVENDER LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4291
Mailing Address - Country:US
Mailing Address - Phone:301-717-2972
Mailing Address - Fax:
Practice Address - Street 1:4234 LAVENDER LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-4291
Practice Address - Country:US
Practice Address - Phone:301-717-2972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPENDING363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily