| NPI | 1962899955 |
|---|---|
| Doing Business As | WAVERLY HEALTH & FITNESS CENTER |
| Entity Type | Organization |
| Authorized Contact | WILLIAM GREEN Managing Agent 410-467-6040 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2015-04-17 |
| Last Update Date | 2015-04-17 |