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General NPI Number Information
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NPI Number | 1336052869
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Entity Type | Organization
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Legal Business Name | MIRACLE HEALTHCARE AND WELLNESS CENTER LLC
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Dates
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Enumeration Date | 09/25/2026
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Last Update Date | 09/25/2026
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Provider Practice Location Address
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Address Line | 2408 PLENTY GATES LN # A
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City | WALDORF
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State | MD
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Zip | 20601-5602
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Country | US
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Telephone | 130-161-3696
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Fax |
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Provider Business Mailing Address
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Address Line | 2408 PLENTY GATES LN # A
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City | WALDORF
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State | MD
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Zip | 20601-5602
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Country | US
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Telephone | 130-161-3696
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TOYIN MARY AJAYI
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Credential | DNP,FNP-BC
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Telephone | 301-613-6963
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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