Healthcare Provider Details

I. General information

NPI: 1528419561
Provider Name (Legal Business Name): NEW ERA WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5411 OLD FREDERICK RD STE 2
BALTIMORE MD
21229-2126
US

IV. Provider business mailing address

5411 OLD FREDERICK RD STE 2
BALTIMORE MD
21229-2126
US

V. Phone/Fax

Practice location:
  • Phone: 410-775-6394
  • Fax:
Mailing address:
  • Phone: 410-775-6394
  • Fax: 410-881-2477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR157786
License Number StateMD

VIII. Authorized Official

Name: MS. MYRTIS MARVELL-MCCAIN AGEN-DAVIS
Title or Position: FAMILY NURSE PRACTITIONER
Credential: PMHNP-BC, FNP-C
Phone: 410-775-6394