Provider Demographics
NPI:1891260048
Name:NTUI, DI LEONEL NTUI
Entity Type:Individual
Prefix:
First Name:DI LEONEL
Middle Name:NTUI
Last Name:NTUI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14010 LAKE MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-3812
Mailing Address - Country:US
Mailing Address - Phone:240-515-2355
Mailing Address - Fax:
Practice Address - Street 1:780 FAIRVIEW AVE APT 507
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-5950
Practice Address - Country:US
Practice Address - Phone:240-515-2355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR228821363LP0808X
DCRN1047013163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty