Healthcare Provider Details

I. General information

NPI: 1518534411
Provider Name (Legal Business Name): A BEAUTIFUL EXPERIENCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 06/09/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1654 NORTHGATE RD
BALTIMORE MD
21218-1650
US

IV. Provider business mailing address

1654 NORTHGATE RD
BALTIMORE MD
21218-1650
US

V. Phone/Fax

Practice location:
  • Phone: 443-854-9341
  • Fax:
Mailing address:
  • Phone: 443-854-9341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2472R0900X
TaxonomyRenal Dialysis Technician
License Number
License Number State

VIII. Authorized Official

Name: RASHEEDA JAMEELAH ALFORD
Title or Position: DIRECTOR
Credential: RN BSN, CHES, DOULA
Phone: 443-854-9341