Healthcare Provider Details

I. General information

NPI: 1841039898
Provider Name (Legal Business Name): JJDLIGHTCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8719 TIMBER OAK LN
LAUREL MD
20723-5919
US

IV. Provider business mailing address

7148 NATURES RD
COLUMBIA MD
21046-1606
US

V. Phone/Fax

Practice location:
  • Phone: 443-927-9694
  • Fax: 443-927-9694
Mailing address:
  • Phone: 443-927-9694
  • Fax: 443-927-9694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. SIDONIE HEUMEN
Title or Position: NURSE PRACTITIONER
Credential:
Phone: 443-927-9694