Healthcare Provider Details

I. General information

NPI: 1124695143
Provider Name (Legal Business Name): ONSITE MEDICAL PALLIATIVE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 CHESSIE CROSSING WAY
WOODBINE MD
21797-8768
US

IV. Provider business mailing address

760 CHESSIE CROSSING WAY
WOODBINE MD
21797-8768
US

V. Phone/Fax

Practice location:
  • Phone: 410-255-0102
  • Fax:
Mailing address:
  • Phone: 410-255-0102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: NICOLE BACHMANN
Title or Position: OWNER
Credential:
Phone: 443-694-5555