Healthcare Provider Details

I. General information

NPI: 1366257925
Provider Name (Legal Business Name): MINNETTE HEALTHCARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7375 EXECUTIVE PL STE 100
LANHAM MD
20706-6234
US

IV. Provider business mailing address

12812 WILLOW MARSH LN
BOWIE MD
20720-4692
US

V. Phone/Fax

Practice location:
  • Phone: 240-564-5989
  • Fax:
Mailing address:
  • Phone: 240-564-5989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: THERESA ANOKAM
Title or Position: OWNER
Credential: NP
Phone: 240-564-5989