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General NPI Number Information
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NPI Number | 1033821830
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Entity Type | Organization
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Legal Business Name | HORMONES & IMMUNOLOGY PERSONALIZED MEDICINE
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Dates
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Enumeration Date | 12/23/2022
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Last Update Date | 02/09/2023
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Provider Practice Location Address
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Address Line | 100 OWINGS CT STE 12
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City | REISTERSTOWN
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State | MD
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Zip | 21136-6434
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Country | US
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Telephone | 443-204-1134
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Fax |
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Provider Business Mailing Address
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Address Line | 9954 SHOSHONE WAY
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-1739
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Country | US
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Telephone | 443-204-1134
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAVON MAGRUDER
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Credential | CRNP
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Telephone | 443-204-1134
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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