Provider Demographics
NPI:1417492141
Name:LIFETOUCH CLINICAL CONSULTANTS,LLC
Entity Type:Organization
Organization Name:LIFETOUCH CLINICAL CONSULTANTS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:ESABELLA
Authorized Official - Middle Name:MAH
Authorized Official - Last Name:TEBID MBAH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:202-257-2130
Mailing Address - Street 1:4512 DOCTOR BEANS LEGACY CIR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-6384
Mailing Address - Country:US
Mailing Address - Phone:202-257-2130
Mailing Address - Fax:
Practice Address - Street 1:4512 DOCTOR BEANS LEGACY CIR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-6384
Practice Address - Country:US
Practice Address - Phone:202-257-2130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR174293261QP2300X
DCRN1009165261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care