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General NPI Number Information
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NPI Number | 1013876879
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Entity Type | Organization
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Legal Business Name | HEALTHSPAN COMPREHENSIVE HEALTH
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Dates
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Enumeration Date | 01/19/2026
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Last Update Date | 01/26/2026
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Provider Practice Location Address
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Address Line | 5502 EDMONDSON AVE
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City | BALTIMORE
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State | MD
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Zip | 21229-2220
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Country | US
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Telephone | 410-988-4418
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Fax |
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Provider Business Mailing Address
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Address Line | 4380B MONTGOMERY RD # 1051
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City | ELLICOTT CITY
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State | MD
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Zip | 21043-6006
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PETERSON NGUYEN
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Credential | PMHNP, CRNP
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Telephone | 410-988-4418
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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