Provider Demographics
NPI:1215656095
Name:KEM BUMBALA, PERPETUA MANDA
Entity type:Individual
Prefix:
First Name:PERPETUA
Middle Name:MANDA
Last Name:KEM BUMBALA
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 1:9891 GOOD LUCK RD APT 7
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3239
Mailing Address - Country:US
Mailing Address - Phone:301-523-4949
Mailing Address - Fax:
Practice Address - Street 1:9891 GOOD LUCK RD APT 7
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3239
Practice Address - Country:US
Practice Address - Phone:301-523-4949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC20001751374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide