Individual
MR. IMMANUEL VAN SLYKE JOSEPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
8811 SUMNER GROVE DR, LAUREL, MD 20708-3533
(240) 355-3266
Mailing address
8811 SUMNER GROVE DR, LAUREL, MD 20708-3533
(240) 355-3266
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
R180947
MD
Other
Enumeration date
12/04/2023
Last updated
12/04/2023
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