Immanuel Van Slyke Joseph, RN
Registered Nurse, General Practice in Laurel, MD. Individual provider (NPI-1).
NPI number1932975638
StatusActive
Last updated in NPPESDec 4, 2023
Details
- NPI
- 1932975638
- Entity type
- Individual (NPI-1)
- Name
- Mr. Immanuel Van Slyke Joseph
- Credential
- RN
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Dec 4, 2023
- Certification date
- Dec 4, 2023
- Last updated
- Dec 4, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 163WG0000X | Registered Nurse, General Practice | R180947 | MD | Yes |
Practice location
8811 Sumner Grove DrLaurel, MD 20708-3533
Phone 240-355-3266
Mailing address
8811 Sumner Grove DrLaurel, MD 20708-3533
Phone 240-355-3266
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