Organization
GOFAN HEALTHCARE SERVICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACINTA MADU (OWNER)
(804) 469-0044
Entity
Organization
Contact information
Practice address
6200 BALTIMORE AVE STE 300, RIVERDALE, MD 20737-1054
(469) 296-8177
(469) 722-5748
Mailing address
2072 ROYAL ACRES TRL, FRISCO, TX 75036-8772
(469) 296-8177
(972) 435-4426
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
12/23/2024
Last updated
12/23/2024
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