Healthcare Provider Details

I. General information

NPI: 1083521330
Provider Name (Legal Business Name): HAVEN HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 LIGHT ST FL 1
BALTIMORE MD
21230-4376
US

IV. Provider business mailing address

531 WRIGHTS LN
ESSEX MD
21221-1641
US

V. Phone/Fax

Practice location:
  • Phone: 443-717-2302
  • Fax:
Mailing address:
  • Phone: 443-717-2302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. ALLY NICOLE KRANNEBITTER
Title or Position: MANAGING MEMBER/NP
Credential: DNP, APRN, FNP-C
Phone: 443-717-2302