| Familycare Nurse Practitioner Llc | |
|
2300 Garrison Blvd Ste 100 Baltimore MD 21216-2308 | |
| (410) 945-2289 | |
| (410) 945-4255 |
| Full Name | Familycare Nurse Practitioner Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2300 Garrison Blvd Ste 100, Baltimore, Maryland |
| Authorized Official Name and Position | Ngwanma Nwokoro (CEO) |
| Authorized Official Contact | 4109452289 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Familycare Nurse Practitioner Llc 2300 Garrison Blvd Ste 100 Baltimore MD 21216-2308 Ph: (410) 945-2289 | Familycare Nurse Practitioner Llc 2300 Garrison Blvd Ste 100 Baltimore MD 21216-2308 Ph: (410) 945-2289 |
| NPI Number | 1821628801 |
|---|---|
| Provider Enumeration Date | 01/19/2020 |
| Last Update Date | 01/19/2020 |
| Medicare PECOS PAC ID | 5395160402 |
|---|---|
| Medicare Enrollment ID | O20200806002552 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821628801 | NPI | - | NPPES |
| 772050500 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Ngwanma Alvanis Nwokoro |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740776632 PECOS PAC ID: 6204251317 Enrollment ID: I20200806002714 |
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