Provider Demographics
NPI:1528762507
Name:BRIGHT STAR FAMILY CLINIC INC
Entity type:Organization
Organization Name:BRIGHT STAR FAMILY CLINIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LOVINNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ONYEJIAKA
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:240-886-5255
Mailing Address - Street 1:7206 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-2751
Mailing Address - Country:US
Mailing Address - Phone:240-886-5255
Mailing Address - Fax:301-273-3543
Practice Address - Street 1:7505 NEW HAMPSHIRE AVE STE 308
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6972
Practice Address - Country:US
Practice Address - Phone:240-847-7165
Practice Address - Fax:240-641-8970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-27
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center