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General NPI Number Information
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NPI Number | 1962279455
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Entity Type | Organization
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Legal Business Name | EXCLUSIV NP CONCIERGE
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Dates
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Enumeration Date | 12/05/2023
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Last Update Date | 12/05/2023
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Provider Practice Location Address
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Address Line | 5457 TWIN KNOLLS RD STE 300
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City | COLUMBIA
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State | MD
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Zip | 21045-3296
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Country | US
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Telephone | 980-370-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 5457 TWIN KNOLLS RD STE 300
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City | COLUMBIA
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State | MD
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Zip | 21045-3296
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TASHANA JOHNSON
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Credential | CRNP
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Telephone | 980-370-4400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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