Provider Demographics
NPI:1326842857
Name:LIFE AND DESTINY HEALTH
Entity type:Organization
Organization Name:LIFE AND DESTINY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SELASI
Authorized Official - Last Name:KWAMI
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-BC
Authorized Official - Phone:401-499-8669
Mailing Address - Street 1:2 YALE AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-5235
Mailing Address - Country:US
Mailing Address - Phone:401-999-2323
Mailing Address - Fax:401-382-3802
Practice Address - Street 1:2 YALE AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-5235
Practice Address - Country:US
Practice Address - Phone:401-999-2323
Practice Address - Fax:401-382-3802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty