Healthcare Provider Details

I. General information

NPI: 1275194326
Provider Name (Legal Business Name): ACROSS THE LIFESPAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 06/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 EGG HARBOR RD STE 703
SEWELL NJ
08080-9410
US

IV. Provider business mailing address

PO BOX 170
OZARK AR
72949-0170
US

V. Phone/Fax

Practice location:
  • Phone: 866-243-7203
  • Fax: 833-243-7203
Mailing address:
  • Phone: 866-243-7203
  • Fax: 833-243-7203

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: MARIA LEOTTI
Title or Position: OWNER
Credential:
Phone: 856-418-0484