Provider Demographics
NPI:1760078182
Name:MY HEALTH, LLC
Entity Type:Organization
Organization Name:MY HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MYRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DIATTA
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:202-390-6990
Mailing Address - Street 1:3425 LONDONLEAF LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-2902
Mailing Address - Country:US
Mailing Address - Phone:202-390-6990
Mailing Address - Fax:866-871-7324
Practice Address - Street 1:3425 LONDONLEAF LN
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-2902
Practice Address - Country:US
Practice Address - Phone:202-390-6990
Practice Address - Fax:866-871-7324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-20
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR187091OtherCERTIFIED NURSE PRACTITIONER LICENSE