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General NPI Number Information
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NPI Number | 1366883043
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Entity Type | Organization
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Legal Business Name | OPTIMAL WELLNESS, LLC
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Dates
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Enumeration Date | 07/10/2013
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Last Update Date | 07/10/2013
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Provider Practice Location Address
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Address Line | 1812 BALTIMORE BLVD SUITE C
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City | WESTMINSTER
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State | MD
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Zip | 21157-7146
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Country | US
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Telephone | 410-861-5256
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Fax | 410-861-5258
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Provider Business Mailing Address
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Address Line | 1812 BALTIMORE BLVD SUITE C
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City | WESTMINSTER
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State | MD
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Zip | 21157-7146
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Country | US
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Telephone | 410-861-5256
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Fax | 410-861-5258
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Authorized Official
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Title or Position | OWNER
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Name | LAURA A RUBY
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Credential | D.N.P., C. R. N. P.
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Telephone | 410-861-5256
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | R084575
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License Number State | MD
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