Organization
DIVERSITY HEALTH CLINIC, LLC
Active
Other names
Diversity Health Clinic, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AKUKENG W. MBA CRNP (NURSE PRACTITIONER)
(301) 793-4761
Entity
Organization
Contact information
Practice address
15101 CENTERGATE DR, SILVER SPRING, MD 20905-5714
(301) 793-4761
(800) 519-7417
Mailing address
15101 CENTERGATE DR, SILVER SPRING, MD 20905-5714
(301) 793-4761
(800) 519-7417
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R185268
LICENSE
MD
Enumeration date
11/13/2020
Last updated
11/13/2020
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