Provider Demographics
NPI:1336700251
Name:EXCEPTIONAL PRIMARY AND PREVENTIVE CARE LLC
Entity Type:Organization
Organization Name:EXCEPTIONAL PRIMARY AND PREVENTIVE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FLORENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:ODUBAYO
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:240-277-8294
Mailing Address - Street 1:10301 GEORGIA AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-5020
Mailing Address - Country:US
Mailing Address - Phone:240-277-8294
Mailing Address - Fax:
Practice Address - Street 1:10301 GEORGIA AVE STE 209
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5020
Practice Address - Country:US
Practice Address - Phone:240-277-8294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty