Provider Demographics
NPI:1962765537
Name:MUKUM, JENET
Entity type:Individual
Prefix:
First Name:JENET
Middle Name:
Last Name:MUKUM
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 1:2500 QUEENS CHAPEL RD
Mailing Address - Street 2:APT 3
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-3643
Mailing Address - Country:US
Mailing Address - Phone:240-938-6145
Mailing Address - Fax:
Practice Address - Street 1:2500 QUEENS CHAPEL RD
Practice Address - Street 2:APT 3
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-3643
Practice Address - Country:US
Practice Address - Phone:240-938-6145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide