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General NPI Number Information
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NPI Number | 1881332088
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Entity Type | Organization
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Legal Business Name | CENTREVILLE FAMILY PRACTICE LLC
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Dates
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Enumeration Date | 05/26/2022
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Last Update Date | 06/08/2023
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Provider Practice Location Address
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Address Line | 120 SPEER RD STE 2
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City | CHESTERTOWN
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State | MD
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Zip | 21620-1085
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Country | US
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Telephone | 410-778-1311
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Fax | 414-077-8062
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Provider Business Mailing Address
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Address Line | 120 SPEER RD STE 2
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City | CHESTERTOWN
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State | MD
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Zip | 21620-1085
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Country | US
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Telephone | 410-778-1311
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Fax | 410-778-0623
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Authorized Official
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Title or Position | OWNER
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Name | ANGELA MARIE LUNCZYNSKI
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Credential | NP
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Telephone | 410-778-1311
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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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