Healthcare Provider Details

I. General information

NPI: 1457767519
Provider Name (Legal Business Name): ABBY WETZEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4470 REGENCY PLACE
WHITE PLAINS MD
20695-3071
US

IV. Provider business mailing address

4470 REGENCY PLACE
WHITE PLAINS MD
20695-3071
US

V. Phone/Fax

Practice location:
  • Phone: 301-934-5336
  • Fax: 301-934-0498
Mailing address:
  • Phone: 301-934-5336
  • Fax: 301-934-0498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDX3587
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: