Organization
DIVINE HEALTH MEDICAL AND SPA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SALLY OWIE YOUNG FNP (EDUCATOR)
(240) 437-9997
Entity
Organization
Contact information
Practice address
11119 ROCKVILLE PIKE STE 320, ROCKVILLE, MD 20852-3143
(240) 669-6598
(240) 669-6079
Mailing address
12406 BUCKLEY DR, SILVER SPRING, MD 20904-2017
(240) 437-9997
(240) 669-6079
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
04/19/2022
Last updated
07/14/2022
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