Provider Demographics
NPI:1982410361
Name:TUERK HOUSE, INC.
Entity type:Organization
Organization Name:TUERK HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CBO
Authorized Official - Prefix:
Authorized Official - First Name:KISUN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS-DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-861-2531
Mailing Address - Street 1:2701 N CHARLES ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-4351
Mailing Address - Country:US
Mailing Address - Phone:667-212-3631
Mailing Address - Fax:
Practice Address - Street 1:730 N ASHBURTON ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-4703
Practice Address - Country:US
Practice Address - Phone:667-212-3631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty