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General NPI Number Information
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NPI Number | 1245749498
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Entity Type | Individual
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Provider Name | MRS. CLARA MARYLENE ANNIBAL
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Gender | Female
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Dates
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Enumeration Date | 09/20/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 838 W PRATT STREET
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City | BALTIMORE
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State | MD
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Zip | 21201
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Country | US
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Telephone | 443-972-1078
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Fax |
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Provider Business Mailing Address
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Address Line | 10 LIGHT STREET # 2704
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City | BALTIMORE
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State | MD
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Zip | 21202
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Country | US
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Telephone | 443-972-1078
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number |
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License Number State |
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