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General NPI Number Information
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NPI Number | 1396355129
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Entity Type | Organization
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Legal Business Name | HOLISTIC HEALTH AND WELLNESS LLC
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Dates
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Enumeration Date | 08/06/2020
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Last Update Date | 05/25/2022
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Provider Practice Location Address
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Address Line | 1105 N POINT BLVD STE 321
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City | BALTIMORE
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State | MD
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Zip | 21224-3472
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Country | US
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Telephone | 410-517-7060
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Fax | 443-407-2942
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Provider Business Mailing Address
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Address Line | 1105 N POINT BLVD STE 321
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City | BALTIMORE
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State | MD
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Zip | 21224-3472
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Country | US
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Telephone | 410-517-7060
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Fax | 443-407-2942
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MICHELLE BLACKSTON
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Credential | CRNP
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Telephone | 410-517-7060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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