# LIFEOPTIMIZED - BENNERMEDICAL INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538794250
- **Authorized official:** JAMES NICHOLS (ADMINISTRATOR)
- **Authorized official phone:** (443) 386-6561

## Contact information

- **Practice address:** 14090 HG TRUEMAN RD STE 2300, SOLOMONS, MD 20688-3151
- **Practice address phone:** (443) 386-6561
- **Mailing address:** 16 INGATE TER, ARBUTUS, MD 21227-3849
- **Mailing address phone:** (443) 386-6561

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/04/2020
- **Last updated:** 10/28/2020