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Organization
PROTELIX HEALTH CLINIC LLC
Active
Organization
PROTELIX HEALTH CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THELMA PAINE APRN, FNP-C (OWNER/CEO)
(410) 575-4494
Entity
Organization
Contact information
Practice address
22 W PADONIA RD STE C133, LUTHERVILLE TIMONIUM, MD 21093-2238
(410) 575-4494
Mailing address
1810J YORK RD STE 178, LUTHERVILLE, MD 21093-5118
(410) 575-4494
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
—
—
261Q00000X
Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558629246
—
OH
Enumeration date
02/12/2021
Last updated
05/10/2023
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