| NPI | 1154139640 |
|---|---|
| Doing Business As | MAGNOLIA BODY RENEW |
| Doing Business As | MAGNOLIA HEALTH CARE LLC |
| Entity Type | Organization |
| Authorized Contact | SHAQUILLA VAZQUEZ CLARK Family Nurse Practitioner 410-793-3634 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2024-12-30 |
| Last Update Date | 2024-12-30 |