| NPI | 1215397419 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EARLINE JACKSON Office Manager 301-317-6281 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R133461) |
| Enumeration Date | 2016-03-01 |
| Last Update Date | 2016-03-01 |