Provider Demographics
NPI:1942762570
Name:CONFIDENT CARE MEDICAL LLC
Entity Type:Organization
Organization Name:CONFIDENT CARE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCKEFELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-287-7589
Mailing Address - Street 1:1621 LYMAN PL NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-3007
Mailing Address - Country:US
Mailing Address - Phone:404-287-7589
Mailing Address - Fax:
Practice Address - Street 1:1331 H ST NW STE 200
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-4706
Practice Address - Country:US
Practice Address - Phone:404-287-7589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-02
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC013655992Medicaid