Organization
DERVAN HEALTHCARE SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BLANCHE MOKOSO (FNP)
(301) 728-3783
Entity
Organization
Contact information
Practice address
3849 PENNSYLVANIA AVE SE, WASHINGTON, DC 20020-1309
(301) 728-3783
Mailing address
11303 SPRINGPARK CT, GLENN DALE, MD 20769-9611
(301) 728-3783
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
09/09/2019
Last updated
09/10/2020
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