| NPI | 1215515408 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DREW FULLER Owner 443-622-4317 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207P00000X Emergency Medicine |
| 2083A0300X Preventive Medicine, Addiction Medicine | |
| 363L00000X Nurse Practitioner | |
| 363A00000X Physician Assistant | |
| 363LF0000X Nurse Practitioner, Family | |
| 363LG0600X Nurse Practitioner, Gerontology | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2021-03-30 |
| Last Update Date | 2025-08-04 |