Provider Demographics
NPI:1881471902
Name:PRISTINE HEALTHCARE SERVICES INC
Entity type:Organization
Organization Name:PRISTINE HEALTHCARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FUNMILAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:ONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-593-6255
Mailing Address - Street 1:9405 6TH ST N
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1939
Mailing Address - Country:US
Mailing Address - Phone:240-593-6255
Mailing Address - Fax:
Practice Address - Street 1:9405 6TH ST N
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-1939
Practice Address - Country:US
Practice Address - Phone:240-593-6255
Practice Address - Fax:301-725-0752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-12
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty