Healthcare Provider Details

I. General information

NPI: 1770164527
Provider Name (Legal Business Name): EXQUISITE HEARTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17327 ROCKY MOUNT LN
DUMFRIES VA
22026-3302
US

IV. Provider business mailing address

17327 ROCKY MOUNT LN
DUMFRIES VA
22026-3302
US

V. Phone/Fax

Practice location:
  • Phone: 571-445-0206
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246R00000X
TaxonomyPathology Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: BRITTANY BRENT
Title or Position: OWNER
Credential:
Phone: 571-424-2288