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General NPI Number Information
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NPI Number | 1447968490
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Entity Type | Organization
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Legal Business Name | PRACTICAL LIFE HEALTH SERVICES
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Dates
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Enumeration Date | 11/09/2022
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Last Update Date | 11/09/2022
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Provider Practice Location Address
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Address Line | 1013 CORTANA CT
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City | SEVERN
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State | MD
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Zip | 21144-1185
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Country | US
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Telephone | 667-842-1003
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Fax |
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Provider Business Mailing Address
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Address Line | 1013 CORTANA CT
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City | SEVERN
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State | MD
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Zip | 21144-1185
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Country | US
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Telephone | 667-842-1003
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Fax |
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Authorized Official
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Title or Position | DNP, PMHNP
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Name | OLAYEMI AYILEGBE
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Credential |
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Telephone | 667-842-1003
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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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