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General NPI Number Information
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NPI Number | 1104255744
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Entity Type | Organization
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Legal Business Name | J HEALTHCARE SERVICES AND CONSULTATION
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Dates
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Enumeration Date | 11/04/2013
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Last Update Date | 12/16/2013
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Provider Practice Location Address
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Address Line | 4234 LAVENDER LN
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City | BOWIE
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State | MD
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Zip | 20720-4291
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Country | US
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Telephone | 301-717-2972
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Fax |
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Provider Business Mailing Address
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Address Line | 4234 LAVENDER LN
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City | BOWIE
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State | MD
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Zip | 20720-4291
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Country | US
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Telephone | 301-717-2972
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Fax |
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Authorized Official
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Title or Position | CHAIRMAN
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Name | MR. JOSEPH E KISANGA
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Credential | NP
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Telephone | 301-717-2972
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN1011679
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License Number State | DC
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