Healthcare Provider Details

I. General information

NPI: 1962327346
Provider Name (Legal Business Name): IET HEALTHCARE AND REFERRAL SERVICES, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 SAINT MATTHEWS DR
WALDORF MD
20602-5183
US

IV. Provider business mailing address

5001 SAINT MATTHEWS DR
WALDORF MD
20602-5183
US

V. Phone/Fax

Practice location:
  • Phone: 240-533-1444
  • Fax:
Mailing address:
  • Phone: 240-533-1444
  • Fax: 301-423-1094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RANIER SELORIO DELOS REYES
Title or Position: OWNER
Credential: CRNP
Phone: 240-533-1444