Provider Demographics
NPI:1124762968
Name:BAKATUBALA, LUMIERE TUFUKA (NP)
Entity type:Individual
Prefix:
First Name:LUMIERE
Middle Name:TUFUKA
Last Name:BAKATUBALA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2026 OPITZ BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3332
Mailing Address - Country:US
Mailing Address - Phone:703-491-7155
Mailing Address - Fax:
Practice Address - Street 1:2026 OPITZ BLVD STE A
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3332
Practice Address - Country:US
Practice Address - Phone:703-491-7155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024183787363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health