Healthcare Provider Details

I. General information

NPI: 1104346006
Provider Name (Legal Business Name): CHARITY ALLWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 SANDY SPRING RD STE 110
LAUREL MD
20707-3596
US

IV. Provider business mailing address

7365 CEDAR AVE
JESSUP MD
20794-9456
US

V. Phone/Fax

Practice location:
  • Phone: 301-455-4116
  • Fax: 240-554-2345
Mailing address:
  • Phone: 301-455-4116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR183253
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR183253
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR183253
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: