Healthcare Provider Details

I. General information

NPI: 1972103661
Provider Name (Legal Business Name): MAGNOLIA FAMILY HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2020
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 E 1ST AVE # AVW
OAKLAND MD
21550-2728
US

IV. Provider business mailing address

121 E 1ST AVE
OAKLAND MD
21550-2728
US

V. Phone/Fax

Practice location:
  • Phone: 301-759-3800
  • Fax: 301-777-7455
Mailing address:
  • Phone: 301-759-3800
  • Fax: 301-777-7455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: FAITH ANN RODEHEAVER
Title or Position: OWNER
Credential: CRNP
Phone: 301-759-3800