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General NPI Number Information
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NPI Number | 1417492141
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Entity Type | Organization
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Legal Business Name | LIFETOUCH CLINICAL CONSULTANTS,LLC
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Dates
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Enumeration Date | 01/04/2017
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Last Update Date | 01/23/2017
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Provider Practice Location Address
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Address Line | 4512 DOCTOR BEANS LEGACY CIR
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City | BOWIE
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State | MD
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Zip | 20720-6384
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Country | US
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Telephone | 202-257-2130
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Fax |
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Provider Business Mailing Address
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Address Line | 4512 DOCTOR BEANS LEGACY CIR
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City | BOWIE
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State | MD
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Zip | 20720-6384
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Country | US
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Telephone | 202-257-2130
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Fax |
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Authorized Official
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Title or Position | FNP-BC
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Name | ESABELLA MAH TEBID MBAH
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Credential | NP
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Telephone | 202-257-2130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | RN1009165
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | R174293
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License Number State | MD
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