Healthcare Provider Details

I. General information

NPI: 1275075210
Provider Name (Legal Business Name): GREENSPRING HERBS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9170 ROUTE 108 SUITE 202
COLUMBIA MD
21045-1987
US

IV. Provider business mailing address

12230 GREENPSRING AVE.
OWINGS MILLS MD
21117
US

V. Phone/Fax

Practice location:
  • Phone: 410-258-9625
  • Fax:
Mailing address:
  • Phone: 410-258-9625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDX3409
License Number StateMD

VIII. Authorized Official

Name: MRS. JILLIAN ANN BAR-AV
Title or Position: CLINICAL HERBALIST & NUTRITIONIST
Credential: LDN
Phone: 410-258-9625