Individual
IDARA IBOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
12073 TECH RD STE B, SILVER SPRING, MD 20904-7874
(301) 593-1315
Mailing address
1500 FOREST GLEN RD, SILVER SPRING, MD 20910-1460
(301) 754-7991
(301) 754-7990
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R171690
MD
363LF0000X
Family Nurse Practitioner
R171690
MD
Other
Enumeration date
09/26/2016
Last updated
01/08/2025
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