Healthcare Provider Details

I. General information

NPI: 1184091126
Provider Name (Legal Business Name): IFE SEMPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2015
Last Update Date: 08/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 MOUNT HOLLY ST
BALTIMORE MD
21216-2430
US

IV. Provider business mailing address

2141 MOUNT HOLLY ST
BALTIMORE MD
21216-2430
US

V. Phone/Fax

Practice location:
  • Phone: 443-325-3715
  • Fax:
Mailing address:
  • Phone: 443-325-3715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License NumberCERT. HAIR LOSS SPEC
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: