Healthcare Provider Details

I. General information

NPI: 1770426371
Provider Name (Legal Business Name): MODVIVA HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 BELAIR RD STE 2B
BALTIMORE MD
21206-1855
US

IV. Provider business mailing address

6600 BELAIR RD STE 2B
BALTIMORE MD
21206-1855
US

V. Phone/Fax

Practice location:
  • Phone: 443-687-1421
  • Fax:
Mailing address:
  • Phone: 443-687-1421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: PAWN JOHNSON-HUNTER
Title or Position: NURSE PRACTITIONER
Credential: AGPCNP
Phone: 443-687-1421