Provider Demographics
NPI:1043950686
Name:I & O DIABETES CONSULTANTS LLC
Entity Type:Organization
Organization Name:I & O DIABETES CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DNP
Authorized Official - Prefix:
Authorized Official - First Name:MIESHIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:770-314-2611
Mailing Address - Street 1:2201 CARLTON LN STE B
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-3917
Mailing Address - Country:US
Mailing Address - Phone:770-314-2611
Mailing Address - Fax:
Practice Address - Street 1:18766 JOHN J WILLIAMS HWY STE 306
Practice Address - Street 2:
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-4417
Practice Address - Country:US
Practice Address - Phone:302-985-2520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty