| NPI | 1992433916 |
|---|---|
| Doing Business As | WELLNESS LEGACY LLC |
| Entity Type | Organization |
| Authorized Contact | MARK ANTHONY BERGONIA ISON Co Owner 410-286-1258 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2022-08-09 |
| Last Update Date | 2024-03-27 |