Healthcare Provider Details

I. General information

NPI: 1861148652
Provider Name (Legal Business Name): AT YOUR SERVICE LABS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 APOLLO DR STE 330C
LARGO MD
20774-4795
US

IV. Provider business mailing address

9318 BANDERA ST
LANHAM MD
20706-2411
US

V. Phone/Fax

Practice location:
  • Phone: 443-399-2979
  • Fax:
Mailing address:
  • Phone: 443-399-2979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. EBONY CECILIA PARKER WAUGH
Title or Position: OWNER
Credential: DNP, MSN, RN
Phone: 443-399-2979