Provider Demographics
NPI:1568283547
Name:ELITE WEIGHTLOSS & TRT
Entity type:Organization
Organization Name:ELITE WEIGHTLOSS & TRT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILIENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:NKEMAYIM
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:410-498-7055
Mailing Address - Street 1:1604 RIDGESIDE DR STE B2
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-5240
Mailing Address - Country:US
Mailing Address - Phone:410-498-7055
Mailing Address - Fax:410-862-4191
Practice Address - Street 1:1604 RIDGESIDE DR STE B2
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-5240
Practice Address - Country:US
Practice Address - Phone:410-498-7055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-22
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty