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General NPI Number Information
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NPI Number | 1275134934
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Entity Type | Organization
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Legal Business Name | HEALTHY OPTION CLINIC
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Dates
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Enumeration Date | 11/07/2020
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Last Update Date | 08/02/2021
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Provider Practice Location Address
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Address Line | 8713 HARFORD RD
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City | PARKVILLE
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State | MD
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Zip | 21234-4650
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Country | US
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Telephone | 443-538-1383
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Fax |
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Provider Business Mailing Address
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Address Line | 101 EGYPT FARMS RD
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City | OWINGS MILLS
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State | MD
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Zip | 21117-5043
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Country | US
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Telephone | 443-538-1383
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | MRS. VICTORIA AJAYI
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Credential | NURSE PRACTITIONER
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Telephone | 443-538-1383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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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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