| NPI | 1124704085 |
|---|---|
| Doing Business As | PROACTIVE WELLNESS NP |
| Entity Type | Organization |
| Authorized Contact | KONDI WALTERSSMITH CEO/ Nurse Practitioner 301-741-0307 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QR0800X Clinic/Center, Recovery Care |
| Enumeration Date | 2023-06-26 |
| Last Update Date | 2023-12-06 |