Provider Demographics
NPI:1285373670
Name:MUKUM, PATRICIA ACHEBA (PMHNP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ACHEBA
Last Name:MUKUM
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8402 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-4557
Mailing Address - Country:US
Mailing Address - Phone:240-350-3765
Mailing Address - Fax:
Practice Address - Street 1:8402 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-4557
Practice Address - Country:US
Practice Address - Phone:240-350-3765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1022890163W00000X
DCNP10228902084P0800X
DC1022890363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry