Provider Demographics
NPI:1871874198
Name:AFFINITY SERVICES LLC
Entity type:Organization
Organization Name:AFFINITY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:COLLEEN
Authorized Official - Last Name:PALAKANIS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:443-493-0062
Mailing Address - Street 1:6062 BRIDLE CT
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-1715
Mailing Address - Country:US
Mailing Address - Phone:443-493-0062
Mailing Address - Fax:410-749-2974
Practice Address - Street 1:6062 BRIDLE CT
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-1715
Practice Address - Country:US
Practice Address - Phone:443-493-0062
Practice Address - Fax:410-749-2974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR105366363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS00420Medicare UPIN