Provider Demographics
NPI:1386354819
Name:JUMA, LILIAN ATIENO (RN)
Entity type:Individual
Prefix:
First Name:LILIAN
Middle Name:ATIENO
Last Name:JUMA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8825 MD BUSH DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-1338
Mailing Address - Country:US
Mailing Address - Phone:507-351-2336
Mailing Address - Fax:
Practice Address - Street 1:8825 MD BUSH DR
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-1338
Practice Address - Country:US
Practice Address - Phone:507-351-2336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-23
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95194145163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice