Healthcare Provider Details

I. General information

NPI: 1770298630
Provider Name (Legal Business Name): NU PATHWAY HEALTHCARE AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11974 EDGEHILL TERRACE RD
PRINCESS ANNE MD
21853-2105
US

IV. Provider business mailing address

14300 GALLANT FOX LN STE 202
BOWIE MD
20715-4033
US

V. Phone/Fax

Practice location:
  • Phone: 301-321-7741
  • Fax: 301-291-7071
Mailing address:
  • Phone: 301-321-7741
  • Fax: 301-291-7071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: OWEN GARDNER
Title or Position: OWNER
Credential:
Phone: 301-928-4725