Provider Demographics
NPI:1154012136
Name:MUKUKA, LUCY CHANSA
Entity type:Individual
Prefix:MRS
First Name:LUCY
Middle Name:CHANSA
Last Name:MUKUKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12217 VILLAGE SQUARE TER APT 401
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-1922
Mailing Address - Country:US
Mailing Address - Phone:240-205-9408
Mailing Address - Fax:
Practice Address - Street 1:3701 CONNECTICUT AVE NW STE 1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-4500
Practice Address - Country:US
Practice Address - Phone:240-205-9408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00185476363LG0600X, 376K00000X
MDMT0155913374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No374700000XNursing Service Related ProvidersTechnician