Provider Demographics
NPI:1750151205
Name:DYNAMIC PRIMARY CARE PRACTICE LLC
Entity type:Organization
Organization Name:DYNAMIC PRIMARY CARE PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHIKAEBERE
Authorized Official - Middle Name:C
Authorized Official - Last Name:TOURE
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, CNP, FNP-BC
Authorized Official - Phone:617-458-2002
Mailing Address - Street 1:67 UNION ST UNIT 305
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-7700
Mailing Address - Country:US
Mailing Address - Phone:508-479-8038
Mailing Address - Fax:
Practice Address - Street 1:67 UNION ST UNIT 305
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-7700
Practice Address - Country:US
Practice Address - Phone:508-479-8038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-05
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty