Healthcare Provider Details

I. General information

NPI: 1750160925
Provider Name (Legal Business Name): SKY INFUSIONS AND MEDSPA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 MERCANTILE LN STE 129-9
LARGO MD
20774-5327
US

IV. Provider business mailing address

10713 CASTLETON TURN
UPPER MARLBORO MD
20774-1449
US

V. Phone/Fax

Practice location:
  • Phone: 301-291-5957
  • Fax:
Mailing address:
  • Phone: 301-456-4143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LORITA NKECHI NNAKA
Title or Position: NP
Credential:
Phone: 301-456-4143