Healthcare Provider Details

I. General information

NPI: 1669023974
Provider Name (Legal Business Name): FAIR WINDS WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2019
Last Update Date: 09/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 ACADEMY ST
CAMBRIDGE MD
21613-1958
US

IV. Provider business mailing address

417 ACADEMY ST
CAMBRIDGE MD
21613-1958
US

V. Phone/Fax

Practice location:
  • Phone: 410-228-2474
  • Fax:
Mailing address:
  • Phone: 410-228-2474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIE NUTHALL
Title or Position: OWNER
Credential: LAC
Phone: 410-228-2474