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General NPI Number Information
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NPI Number | 1750151205
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Entity Type | Organization
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Legal Business Name | DYNAMIC PRIMARY CARE PRACTICE LLC
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Dates
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Enumeration Date | 01/05/2024
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 67 UNION ST UNIT 305
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City | NATICK
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State | MA
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Zip | 01760-7700
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Country | US
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Telephone | 508-479-8038
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Fax |
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Provider Business Mailing Address
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Address Line | 67 UNION ST UNIT 305
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City | NATICK
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State | MA
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Zip | 01760-7700
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Country | US
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Telephone | 508-479-8038
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHIKAEBERE C TOURE
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Credential | MSN, CNP, FNP-BC
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Telephone | 617-458-2002
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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 |
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License Number State |
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