Healthcare Provider Details

I. General information

NPI: 1396625851
Provider Name (Legal Business Name): MEDICINE OF ESSENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7029 EVERGREEN DR
WALDORF MD
20601-3334
US

IV. Provider business mailing address

7029 EVERGREEN DR
WALDORF MD
20601
US

V. Phone/Fax

Practice location:
  • Phone: 301-377-3435
  • Fax:
Mailing address:
  • Phone: 301-377-3435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name: LAILA AZSE MOORE
Title or Position: OPERATING MANAGER/OWNER
Credential: LMT, STUDENT LPN
Phone: 301-377-3435