Provider Demographics
NPI:1356732259
Name:ALUMBA, MIRABEL (FNP)
Entity type:Individual
Prefix:
First Name:MIRABEL
Middle Name:
Last Name:ALUMBA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 IRONBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-9483
Mailing Address - Country:US
Mailing Address - Phone:301-442-2744
Mailing Address - Fax:
Practice Address - Street 1:1220 12TH ST SE STE 120
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-3733
Practice Address - Country:US
Practice Address - Phone:202-279-1817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-12
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1008468363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily