| Proactive Wellness Np | |
|
12114 Blue Flag Way Columbia MD 21044 | |
| (301) 741-0307 | |
| Not Available |
| Full Name | Proactive Wellness Np |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 12114 Blue Flag Way, Columbia, Maryland |
| Authorized Official Name and Position | Kondi Walterssmith (CEO/ NURSE PRACTITIONER) |
| Authorized Official Contact | 3017410307 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Proactive Wellness Np 12114 Blue Flag Way Columbia MD 21044 Ph: (301) 741-0307 | Proactive Wellness Np 12114 Blue Flag Way Columbia MD 21044 Ph: (301) 741-0307 |
| NPI Number | 1124704085 |
|---|---|
| Provider Enumeration Date | 06/26/2023 |
| Last Update Date | 12/06/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124704085 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| 261QR0800X | Clinic/center - Recovery Care | (* (Not Available)) | Secondary |
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