Individual
MR. JOSEPH ERNEST KISANGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
4234 LAVENDER LN, BOWIE, MD 20720-4291
(301) 717-2972
Mailing address
4234 LAVENDER LN, BOWIE, MD 20720-4291
(301) 717-2972
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
PENDING
DC
Other
Enumeration date
09/28/2011
Last updated
12/16/2013
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