Healthcare Provider Details

I. General information

NPI: 1780041012
Provider Name (Legal Business Name): HEALTHWISE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2016
Last Update Date: 01/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 N CALVERT ST
BALTIMORE MD
21218-4616
US

IV. Provider business mailing address

PO BOX 19951
BALTIMORE MD
21211-0951
US

V. Phone/Fax

Practice location:
  • Phone: 410-235-3854
  • Fax: 410-235-3854
Mailing address:
  • Phone: 410-235-3854
  • Fax: 410-235-3854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR134703
License Number StateMD

VIII. Authorized Official

Name: MS. MARY-RITA ELIZABETH BLUTE
Title or Position: OWNER / SOLE PROPRIETOR
Credential: CRNP
Phone: 410-235-3854