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General NPI Number Information
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NPI Number | 1356003743
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Entity Type | Organization
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Legal Business Name | DESTINY HEALTHCARE AND WELLNESS LIMITED LIABILITY COMPANY
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Dates
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Enumeration Date | 10/12/2021
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Last Update Date | 08/03/2023
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Provider Practice Location Address
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Address Line | 7060 OAKLAND MILLS RD
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City | COLUMBIA
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State | MD
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Zip | 21046-1694
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Country | US
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Telephone | 410-491-0962
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Fax |
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Provider Business Mailing Address
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Address Line | 6001 CHARLES EDWARD TER
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City | COLUMBIA
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State | MD
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Zip | 21045-5147
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Country | US
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Telephone | 410-491-0962
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Fax |
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Authorized Official
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Title or Position | CRNP
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Name | MR. OLUDAPO RAPHAEL ELUDOYIN
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Credential | FNP
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Telephone | 410-491-0962
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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