| NPI | 1568231298 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NGUFOR FUBE DIVINE President 240-423-8757 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2023-12-21 |
| Last Update Date | 2026-06-04 |