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NPI Code Detail

MEDICARE: EARLY GLOW HEALTH

MEDICARE: EARLY GLOW HEALTH
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number : 1295441947
Entity Type Code : Organization
Provider Name (Legal Business Name) : EARLY GLOW HEALTH
Provider Business Mailing Address
First Line : 12530 FAIRWOOD PKWY STE 102
Second Line :
City : BOWIE
State : MD
Zip : 20720-6357
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 12530 FAIRWOOD PKWY STE 102
Second Line :
City : BOWIE
State : MD
Zip : 20720-6357
Country : US
Telephone Number : 443-681-9588
Fax Number :
Authorized Official
Title or Position : OWNER/PROVIDER
Name : MRS. MELANIE OSEFO
Credential : PMHNP-BC
Telephone Number : 443-681-9588
Provider Enumeration Date : 01/26/2023
Last Update Date : 01/26/2023

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