Provider Demographics
NPI:1104398247
Name:HOUSECALL PRACTITIONER SERVICES LLC
Entity Type:Organization
Organization Name:HOUSECALL PRACTITIONER SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/HEALTHCARE PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:BARBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BONSU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-397-6694
Mailing Address - Street 1:7820B WORMANS MILL RD # 179
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-3034
Mailing Address - Country:US
Mailing Address - Phone:240-397-6694
Mailing Address - Fax:
Practice Address - Street 1:4310 VINE ST
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-5817
Practice Address - Country:US
Practice Address - Phone:240-397-6694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-31
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty