MEDICARE: SIMPLYGYN LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner

General Provider Information

NPI Number	:	1871317719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMPLYGYN LLC

Provider Business Mailing Address
First Line	:	3060 MITCHELLVILLE RD STE 212
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20716-3971
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3060 MITCHELLVILLE RD STE 212
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20716-3971
Country	:	US
Telephone Number	:	301-675-3543
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	ANITA ENADEGHE
Credential	:
Telephone Number	:	301-675-3543

Provider Enumeration Date	:	11/07/2024
Last Update Date	:	01/15/2026

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