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General NPI Number Information
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NPI Number | 1467141622
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Entity Type | Organization
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Legal Business Name | ONE STOP WELLNESS MD LLC
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Dates
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Enumeration Date | 05/03/2023
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Last Update Date | 08/20/2024
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Provider Practice Location Address
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Address Line | 2418 E YORK ST
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City | PHILADELPHIA
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State | PA
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Zip | 19125-3006
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Country | US
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Telephone | 302-273-3926
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Fax |
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Provider Business Mailing Address
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Address Line | 51 E GARWOOD AVE
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City | WILLIAMSTOWN
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State | NJ
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Zip | 08094-1601
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Country | US
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Telephone | 302-273-3926
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIC NURSE PRACTITIONER
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Name | AISHA AYANNA ADDISON
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Credential |
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Telephone | 302-273-3926
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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