Individual ProviderImmaculata UluNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address9500 Annapolis Rd Ste A8, Lanham, MD 20706-2060(240) 582-7866(410) 933-6423PECOS EnrollmentBased on the most recent information from CMS, provider Immaculata Ulu is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records today at 10:04 AM.Profile DetailsProvider ID1740298579Provider TypeIndividualFull NameUlu, ImmaculataCredentialCRNPGenderFemaleSole ProprietorNoEnumeration Date8/4/2006Last Updated2/24/2023Contact InformationPractice LocationPractice Address9500 Annapolis Rd Ste A8, Lanham, MD 20706-2060Phone(240) 582-7866FaxUnlisted FaxMailing LocationMailing Address9910 Franklin Square Dr Ste 2110, Baltimore, MD 21236-4902Phone(410) 933-6423FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363LP0808XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseR107244MarylandCode363LF0000XDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseR107244MarylandProvider IdentifiersIDDescriptionIssuerID112340800DescriptionMedicaidIssuerUnlistedMaryland