Healthcare Provider Details

I. General information

NPI: 1033996673
Provider Name (Legal Business Name): MOUNTAIN VIEW WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 W MAIN ST
HANCOCK MD
21750-1416
US

IV. Provider business mailing address

PO BOX 122
HANCOCK MD
21750-0122
US

V. Phone/Fax

Practice location:
  • Phone: 240-738-0953
  • Fax: 301-238-7386
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMANDA BROOKE BAULER
Title or Position: NURSE PRACTITIONER/OWNER
Credential: CRNP
Phone: 240-738-0954