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General NPI Number Information
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NPI Number | 1821954173
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Entity Type | Organization
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Legal Business Name | LUMENE NEWBORN CONCIERGE LLC
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Dates
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Enumeration Date | 12/30/2025
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 4760 HERSHEL ST
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City | CUMMING
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State | GA
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Zip | 30040-1076
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Country | US
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Telephone | 704-726-4772
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Fax |
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Provider Business Mailing Address
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Address Line | 4760 HERSHEL ST
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City | CUMMING
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State | GA
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Zip | 30040-1076
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Country | US
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Telephone | 704-726-4772
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JANET BOATENG
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Credential | NP
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Telephone | 704-726-4772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State |
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