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General NPI Number Information
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NPI Number | 1962302604
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Entity Type | Organization
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Legal Business Name | DIVINEGRACE PRIMARY URGENT CARE IV HYDRATION & WELLNESS CLINIC LLC
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Dates
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Enumeration Date | 11/06/2026
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Last Update Date | 11/06/2026
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Provider Practice Location Address
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Address Line | 9420 ANNAPOLIS RD STE 103
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City | LANHAM
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State | MD
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Zip | 20706-3033
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Country | US
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Telephone | 240-936-5220
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Fax | 240-436-0043
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Provider Business Mailing Address
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Address Line | 12912 CROSSFIELD DR
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City | BELTSVILLE
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State | MD
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Zip | 20705-6334
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Country | US
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Telephone | 240-936-5220
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Fax | 240-436-0043
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Authorized Official
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Title or Position | OWNER
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Name | GRACE CHIKEZIE
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Credential |
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Telephone | 240-476-9409
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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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