MEDICARE: 1ST CLAS AESTHETICS & HEALTH CARE SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225734569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1ST CLAS AESTHETICS & HEALTH CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	1369 TRALEE CIR
Second Line	:
City	:	ABERDEEN
State	:	MD
Zip	:	21001-2643
Country	:	US
Telephone Number	:	405-881-9773
Fax Number	:

Provider Business Practice Location Address
First Line	:	1020 EDGEWOOD RD
Second Line	:
City	:	EDGEWOOD
State	:	MD
Zip	:	21040-1606
Country	:	US
Telephone Number	:	443-409-6619
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CECILIA L BIBIO
Credential	:	CRNP
Telephone Number	:	405-881-9773

Provider Enumeration Date	:	02/07/2023
Last Update Date	:	02/07/2023

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