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Organization
LIFEOPTIMIZED - BENNERMEDICAL INC
Active
Organization
LIFEOPTIMIZED - BENNERMEDICAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES NICHOLS (ADMINISTRATOR)
(443) 386-6561
Entity
Organization
Contact information
Practice address
14090 HG TRUEMAN RD STE 2300, SOLOMONS, MD 20688-3151
(443) 386-6561
Mailing address
16 INGATE TER, ARBUTUS, MD 21227-3849
(443) 386-6561
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
—
NULL
133N00000X
Nutritionist
—
—
133VN1201X
Obesity and Weight Management Nutrition Registered Dietitian
—
NULL
133VN1201X
Obesity and Weight Management Nutrition Registered Dietitian
—
—
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
NULL
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
03/04/2020
Last updated
10/28/2020
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