Provider Demographics
NPI:1588379580
Name:YOUR BEST LIFE MEDICAL ECLINIC, PLLC
Entity type:Organization
Organization Name:YOUR BEST LIFE MEDICAL ECLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:LATTIMER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:804-554-2272
Mailing Address - Street 1:3905 PEGASI RD
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-2433
Mailing Address - Country:US
Mailing Address - Phone:804-554-2272
Mailing Address - Fax:
Practice Address - Street 1:3905 PEGASI RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23231-2433
Practice Address - Country:US
Practice Address - Phone:804-554-2272
Practice Address - Fax:949-577-4491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1568904399Medicaid