| NPI | 1376203133 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AIRELLE RUCKER-SMITH DNP, CRNP Medical Director/Practice Owner 240-720-7797 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 133N00000X Nutritionist |
| 251E00000X Home Health | |
| 261QH0100X Clinic/Center Health Service | |
| 261QP2300X Clinic/Center Primary Care | |
| 363L00000X Nurse Practitioner | |
| 363LG0600X Nurse Practitioner Gerontology | |
| 363LP0200X Nurse Practitioner Pediatrics | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| 363LP2300X Nurse Practitioner Primary Care | |
| Enumeration Date | 2021-12-21 |
| Last Update Date | 2025-07-09 |