=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184231888
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HANEI HEALTH SOLUTIONS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2020
-----------------------------------------------------
Last Update Date | 02/23/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1420 MERRITT BLVD STE B
-----------------------------------------------------
City | DUNDALK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21222-2192
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-741-2488
-----------------------------------------------------
Fax | 240-306-9325
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 451 N HUNGERFORD DR STE 119 RM 114
-----------------------------------------------------
City | ROCKVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20850-5148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-741-2488
-----------------------------------------------------
Fax | 561-584-7338
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JUDDY MORGAN
-----------------------------------------------------
Credential | CRNP
-----------------------------------------------------
Telephone | 786-246-7326
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------