Healthcare Provider Details

I. General information

NPI: 1699344390
Provider Name (Legal Business Name): VICKI WUEST MS, CNS, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2021
Last Update Date: 06/18/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7130 MINSTREL WAY STE 160
COLUMBIA MD
21045-5336
US

IV. Provider business mailing address

838 HOLLY DR E
ANNAPOLIS MD
21409-5518
US

V. Phone/Fax

Practice location:
  • Phone: 410-312-9922
  • Fax:
Mailing address:
  • Phone: 410-336-5507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDX5254
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: