Healthcare Provider Details

I. General information

NPI: 1063011716
Provider Name (Legal Business Name): FIDICLE HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2020
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9110 MCHENRY LN
LANHAM MD
20706-4158
US

IV. Provider business mailing address

9110 MCHENRY LN
LANHAM MD
20706-4158
US

V. Phone/Fax

Practice location:
  • Phone: 240-644-2138
  • Fax:
Mailing address:
  • Phone: 240-644-2138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CLEMENTINE NJINKENG
Title or Position: OWNER
Credential: NP
Phone: 240-644-2138