Healthcare Provider Details

I. General information

NPI: 1588593693
Provider Name (Legal Business Name): MODERN HEALTHCARE FOR THE MODERN ADULT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 W REDWOOD ST STE 201
BALTIMORE MD
21201-1708
US

IV. Provider business mailing address

306 W REDWOOD ST STE 201
BALTIMORE MD
21201-1708
US

V. Phone/Fax

Practice location:
  • Phone: 240-253-6945
  • Fax:
Mailing address:
  • Phone: 240-253-6945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BRENDA MILLS-LAYNE
Title or Position: AUTHORIZED OFFICIAL/ OWNER
Credential:
Phone: 301-602-4896