Active NPI
Gustav Achu
- Licensed Practical Nurse
- Upper Marlboro, MD
National Provider Identifier
1275935843
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- LPN1007763
- Practice address
- 120 College Station Dr
Upper Marlboro, MD 20774-1233 - Phone
- (763) 291-7145
- NPI assigned
- Sep 25, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | LPN1007763 | DC | Primary |
Addresses
Primary practice location
120 College Station Dr
Upper Marlboro, MD 20774-1233
Mailing address
120 College Station Dr
Upper Marlboro, MD 20774-1233
Phone (763) 291-7145
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPN1007763 | DC | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1411603200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1411603200000",
"number": "1275935843",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "120 COLLEGE STATION DR",
"city": "UPPER MARLBORO",
"state": "MD",
"postal_code": "207741233",
"telephone_number": "763-291-7145"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 COLLEGE STATION DR",
"city": "UPPER MARLBORO",
"state": "MD",
"postal_code": "207741233",
"telephone_number": "763-291-7145"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ACHU",
"first_name": "GUSTAV",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-09-25",
"last_updated": "2014-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "DC",
"license": "LPN1007763",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Upper Marlboro, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.