Provider Demographics
NPI:1235730318
Name:MY CLINICAL COORDINATOR LLC
Entity Type:Organization
Organization Name:MY CLINICAL COORDINATOR LLC
Other - Org Name:DOCTOR B THE NP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:BIANCA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:202-813-0944
Mailing Address - Street 1:11720 BELTSVILLE DR STE 500-A44
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3166
Mailing Address - Country:US
Mailing Address - Phone:202-813-0944
Mailing Address - Fax:
Practice Address - Street 1:11720 BELSVILLE DRIVE
Practice Address - Street 2:SUITE 500-A44
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705
Practice Address - Country:US
Practice Address - Phone:202-813-0944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-04
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty