| NPI | 1528318896 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRUDENCE A MANCHO Owner 301-807-6957 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD 2011002215) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MD R149483) |
| Enumeration Date | 2012-09-14 |
| Last Update Date | 2013-05-16 |