Healthcare Provider Details

I. General information

NPI: 1568384709
Provider Name (Legal Business Name): BECOMING YOU MEDICAL WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8548 FORT SMALLWOOD RD
PASADENA MD
21122-2633
US

IV. Provider business mailing address

418 LAUREL OAK LN
SEVEN VALLEYS PA
17360-8721
US

V. Phone/Fax

Practice location:
  • Phone: 240-877-2697
  • Fax: 240-776-7256
Mailing address:
  • Phone: 223-370-2752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NICOLE GULLO
Title or Position: OWNER
Credential: APRN, FNP-C
Phone: 223-370-2752