| Moonglade Integrative Llc | |
|
3233b Chestnut Ridge Rd Grantsville MD 21536-1370 | |
| (240) 321-2770 | |
| Not Available |
| Full Name | Moonglade Integrative Llc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 3233b Chestnut Ridge Rd, Grantsville, Maryland |
| Authorized Official Name and Position | Jennifer Lynn Resh (EMPLOYEE) |
| Authorized Official Contact | 2403212770 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Moonglade Integrative Llc 300 Stiff Rd Addison PA 15411-2057 Ph: (240) 321-2770 | Moonglade Integrative Llc 3233b Chestnut Ridge Rd Grantsville MD 21536-1370 Ph: (240) 321-2770 |
| NPI Number | 1568245595 |
|---|---|
| Provider Enumeration Date | 08/15/2023 |
| Last Update Date | 02/12/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568245595 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
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