Healthcare Provider Details

I. General information

NPI: 1255113262
Provider Name (Legal Business Name): URBANA SPINE AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8927 FINGERBOARD RD STE B
FREDERICK MD
21704-8164
US

IV. Provider business mailing address

8927 FINGERBOARD RD STE B
FREDERICK MD
21704-8164
US

V. Phone/Fax

Practice location:
  • Phone: 240-656-5600
  • Fax: 240-599-1502
Mailing address:
  • Phone: 240-656-5600
  • Fax: 240-599-1502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MELISSA R BOLDEN
Title or Position: MEMBER
Credential: CRNP
Phone: 301-606-1200