CUSTOM MADE WEIGHT LOSS AND NURSING SOLUTIONS NPI 1093361057

NPI Information

  • NPI: 1093361057
  • Provider Name: CUSTOM MADE WEIGHT LOSS AND NURSING SOLUTIONS
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Organization
  • CLIA Number: 21D2158891
  • Address: 413 MAIN ST STE 3
    LAUREL, MD
    ZIP 20707
  • Phone: (240) 294-4079

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NPI Details

CUSTOM MADE WEIGHT LOSS AND NURSING SOLUTIONS is a family nurse practitioner in Laurel, MD. CUSTOM MADE WEIGHT LOSS AND NURSING SOLUTIONS NPI is 1093361057. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

413 MAIN ST STE 3
LAUREL, MD
ZIP 20707-101
Phone: (240) 294-4079
Fax: (240) 559-0085

The provider's authorized official is Bermesola M Dyer .
The authorized official title is President and has the following contact phone number (202) 505-5207.

The CLIA number assigned to this NPI record is 21D2158891 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/15/2019 and was last updated on 12/15/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LF0000XNurse PractitionerFamilyYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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