MEDICARE: CONFIDENT CARE MEDICAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942762570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONFIDENT CARE MEDICAL LLC

Provider Business Mailing Address
First Line	:	1621 LYMAN PL NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20002-3007
Country	:	US
Telephone Number	:	404-287-7589
Fax Number	:

Provider Business Practice Location Address
First Line	:	1331 H ST NW STE 200
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20005-4706
Country	:	US
Telephone Number	:	404-287-7589
Fax Number	:

Authorized Official
Title or Position	:	FNP
Name	:	MARY ROCKEFELLER
Credential	:
Telephone Number	:	404-287-7589

Provider Enumeration Date	:	04/02/2019
Last Update Date	:	07/03/2019

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Directions to “CONFIDENT CARE MEDICAL LLC ” Practice Location

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