Healthcare Provider Details

I. General information

NPI: 1376293399
Provider Name (Legal Business Name): MRS. GINGER LYNN PRATHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11719 HENLEY CT
WALDORF MD
20602-4101
US

IV. Provider business mailing address

11719 HENLEY CT
WALDORF MD
20602-4101
US

V. Phone/Fax

Practice location:
  • Phone: 301-412-0469
  • Fax:
Mailing address:
  • Phone: 301-412-0469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: