=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639995012
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE CLINIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2024
-----------------------------------------------------
Last Update Date | 12/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10770 COLUMBIA PIKE # 300-1104
-----------------------------------------------------
City | SILVER SPRING
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20901-4402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-200-8640
-----------------------------------------------------
Fax | 234-409-4121
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10770 COLUMBIA PIKE # 300-1104
-----------------------------------------------------
City | SILVER SPRING
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20901-4402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-200-8640
-----------------------------------------------------
Fax | 234-409-4121
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER AND FOUNDER
-----------------------------------------------------
Name | LUCIA SILVA VANORMER
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 301-200-8640
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------