Provider Demographics
NPI:1942540083
Name:MAXIMUANGU, LUM MERCY (NP)
Entity Type:Individual
Prefix:
First Name:LUM
Middle Name:MERCY
Last Name:MAXIMUANGU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1201 COLLEGE PARK DR STE 101
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-8702
Mailing Address - Country:US
Mailing Address - Phone:302-741-0226
Mailing Address - Fax:302-741-0335
Practice Address - Street 1:40 S DUNDALK AVE STE 400
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-4273
Practice Address - Country:US
Practice Address - Phone:410-431-1957
Practice Address - Fax:410-862-0150
Is Sole Proprietor?:No
Enumeration Date:2013-02-27
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR150156363LA2100X
DE0000123363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care