Provider Demographics
NPI:1255893061
Name:NJUGUNA, IRENE W (AGNP)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:W
Last Name:NJUGUNA
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4307 SILVER SPRING RD
Mailing Address - Street 2:
Mailing Address - City:PERRY HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21128-9656
Mailing Address - Country:US
Mailing Address - Phone:410-948-5355
Mailing Address - Fax:
Practice Address - Street 1:4307 SILVER SPRING RD
Practice Address - Street 2:
Practice Address - City:PERRY HALL
Practice Address - State:MD
Practice Address - Zip Code:21128-9656
Practice Address - Country:US
Practice Address - Phone:410-948-5355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAG03190100363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology