| NPI | 1003695032 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHEILA DIANE WALLER Proprietor/Authorized Executive 443-531-6248 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Additional Taxonomies | 261Q00000X |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 261QP2300X Clinic/Center, Primary Care | |
| 261QU0200X Clinic/Center, Urgent Care | |
| 302F00000X Exclusive Provider Organization | |
| 363LX0106X Nurse Practitioner, Occupational Health | |
| Enumeration Date | 2023-09-28 |
| Last Update Date | 2023-09-28 |