Healthcare Provider Details

I. General information

NPI: 1841042892
Provider Name (Legal Business Name): KARMEN SHANICE MCMILLAN DOULA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 04/03/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15251 SIESTA KEY WAY APT 304
ROCKVILLE MD
20850-5507
US

IV. Provider business mailing address

10 CENTER DR
BETHESDA MD
20889-0001
US

V. Phone/Fax

Practice location:
  • Phone: 210-842-0276
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number03774
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: