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General NPI Number Information
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NPI Number | 1235730318
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Entity Type | Organization
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Legal Business Name | MY CLINICAL COORDINATOR LLC
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Dates
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Enumeration Date | 11/04/2020
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Last Update Date | 04/01/2021
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Provider Practice Location Address
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Address Line | 11720 BELSVILLE DRIVE SUITE 500-A44
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City | BELTSVILLE
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State | MD
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Zip | 20705
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Country | US
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Telephone | 202-813-0944
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Fax |
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Provider Business Mailing Address
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Address Line | 11720 BELTSVILLE DR STE 500-A44
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City | BELTSVILLE
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State | MD
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Zip | 20705-3166
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Country | US
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Telephone | 202-813-0944
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | BIANCA LEE WILLIAMS
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Credential | DNP
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Telephone | 202-813-0944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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