| NPI | 1134777576 |
|---|---|
| Other Name | WELLNESS LEGACY LLC |
| Entity Type | Organization |
| Authorized Contact | MARK ISON Co Owner 410-286-1258 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2019-08-28 |
| Last Update Date | 2024-03-27 |