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General NPI Number Information
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NPI Number | 1528844693
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Entity Type | Organization
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Legal Business Name | LOVE THE TREE OF LIFE CLINIC
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Dates
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Enumeration Date | 09/05/2023
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Last Update Date | 09/05/2023
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Provider Practice Location Address
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Address Line | 2016 25TH ST
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City | NEWPORT NEWS
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State | VA
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Zip | 23607-5512
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Country | US
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Telephone | 757-726-7135
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Fax |
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Provider Business Mailing Address
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Address Line | 2016 25TH ST
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City | NEWPORT NEWS
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State | VA
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Zip | 23607-5512
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Country | US
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Telephone | 757-915-5781
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, FOUNDER, CLINICAN
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Name | DR. CARMEN I. JOHNSON-MARTELL DNP, FNP-D
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Credential | DNP, FNP-C
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Telephone | 757-915-5781
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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