Healthcare Provider Details

I. General information

NPI: 1639005267
Provider Name (Legal Business Name): PROMETHEAN HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6609 FAIRMOUNT AVE
BALTIMORE MD
21215-1906
US

IV. Provider business mailing address

1019 MIDLAND AVE
YORK PA
17403-3339
US

V. Phone/Fax

Practice location:
  • Phone: 917-861-2531
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KISUN PETERS-DIAZ
Title or Position: FOUNDER / OWNER
Credential:
Phone: 917-861-2531