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General NPI Number Information
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NPI Number | 1174234249
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Entity Type | Organization
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Legal Business Name | JLOVE LEGACY LLC
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Dates
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Enumeration Date | 12/09/2022
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Last Update Date | 12/09/2022
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Provider Practice Location Address
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Address Line | 145 W OSTEND ST STE 300
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City | BALTIMORE
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State | MD
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Zip | 21230-7030
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Country | US
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Telephone | 240-650-9825
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Fax |
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Provider Business Mailing Address
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Address Line | 2631 HOUSLEY RD # 1033
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City | ANNAPOLIS
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State | MD
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Zip | 21401-7030
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JANE FRANCIS NDENKA
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Credential | NP
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Telephone | 405-420-3471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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