Provider Demographics
NPI:1699524553
Name:SP-HEALTHCARE LLC
Entity type:Organization
Organization Name:SP-HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:GINETTE
Authorized Official - Middle Name:F
Authorized Official - Last Name:NDINGUE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:240-893-1889
Mailing Address - Street 1:8210 CASTANEA LN
Mailing Address - Street 2:
Mailing Address - City:DERWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20855-2581
Mailing Address - Country:US
Mailing Address - Phone:240-893-1889
Mailing Address - Fax:866-559-0928
Practice Address - Street 1:8210 CASTANEA LN
Practice Address - Street 2:
Practice Address - City:DERWOOD
Practice Address - State:MD
Practice Address - Zip Code:20855-2581
Practice Address - Country:US
Practice Address - Phone:240-893-1889
Practice Address - Fax:866-559-0928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty