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General NPI Number Information
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NPI Number | 1174192413
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Entity Type | Organization
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Legal Business Name | HOLISTIC TRACK INCORPORATED
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Dates
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Enumeration Date | 06/22/2021
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Last Update Date | 06/22/2021
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Provider Practice Location Address
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Address Line | 110 PAINTERS MILL RD STE 108
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City | OWINGS MILLS
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State | MD
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Zip | 21117-5545
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Country | US
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Telephone | 240-552-0264
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Fax |
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Provider Business Mailing Address
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Address Line | 2504 SOMERTON CT
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City | BOWIE
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State | MD
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Zip | 20721-2979
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Country | US
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Telephone | 240-552-0264
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | EVARIST O OGUGUO
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Credential | PMHNP
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Telephone | 240-552-0264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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