Healthcare Provider Details

I. General information

NPI: 1497093827
Provider Name (Legal Business Name): SOULS IN HARMONY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2013
Last Update Date: 01/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 LIBERTY HEIGHTS AVE
BALTIMORE MD
21207-7056
US

IV. Provider business mailing address

5115 LIBERTY HEIGHTS AVE
BALTIMORE MD
21207-7056
US

V. Phone/Fax

Practice location:
  • Phone: 410-466-8686
  • Fax: 410-466-5949
Mailing address:
  • Phone: 410-466-8686
  • Fax: 410-466-5949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateMD

VIII. Authorized Official

Name: ASMA INGE
Title or Position: PRESIDENT
Credential:
Phone: 410-466-8686