| NPI | 1154888048 |
|---|---|
| Other Name | HENRY WISE WELLNESS CENTER |
| Entity Type | Organization |
| Authorized Contact | ARTIE LEE TRAVIS Vice President Student Affairs 301-860-3390 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health |
| Additional Taxonomies | 202K00000X |
| 207R00000X Internal Medicine | |
| 363LX0001X Nurse Practitioner, Obstetrics & Gynecology | |
| Enumeration Date | 2019-02-27 |
| Last Update Date | 2019-02-27 |