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General NPI Number Information
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NPI Number | 1104398247
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Entity Type | Organization
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Legal Business Name | HOUSECALL PRACTITIONER SERVICES LLC
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Dates
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Enumeration Date | 12/31/2018
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Last Update Date | 12/31/2018
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Provider Practice Location Address
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Address Line | 4310 VINE ST
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City | CAPITOL HEIGHTS
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State | MD
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Zip | 20743-5817
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Country | US
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Telephone | 240-397-6694
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Fax |
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Provider Business Mailing Address
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Address Line | 7820B WORMANS MILL RD # 179
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City | FREDERICK
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State | MD
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Zip | 21701-3034
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Country | US
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Telephone | 240-397-6694
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Fax |
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Authorized Official
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Title or Position | OWNER/HEALTHCARE PROVIDER
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Name | BARBRA BONSU
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Credential |
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Telephone | 240-397-6694
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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