Healthcare Provider Details

I. General information

NPI: 1992620421
Provider Name (Legal Business Name): UR WELLNESS INTEGRATED CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

849 FAIRMOUNT AVE STE 200
TOWSON MD
21286-2693
US

IV. Provider business mailing address

849 FAIRMOUNT AVE STE 200
TOWSON MD
21286-2693
US

V. Phone/Fax

Practice location:
  • Phone: 410-983-3349
  • Fax: 410-403-0332
Mailing address:
  • Phone: 410-983-3349
  • Fax: 410-403-0332

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: MS. SHAWNETTE GOINS
Title or Position: OWNER
Credential: NP
Phone: 667-328-9051