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General NPI Number Information
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NPI Number | 1467158998
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Entity Type | Organization
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Legal Business Name | WELLNESS EGO, LLC
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Dates
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Enumeration Date | 02/06/2023
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Last Update Date | 02/06/2023
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Provider Practice Location Address
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Address Line | 12820 RIVER RD STE HGH
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City | POTOMAC
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State | MD
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Zip | 20854-1139
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Country | US
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Telephone | 240-762-1279
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Fax |
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Provider Business Mailing Address
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Address Line | 9812 FALLS RD STE 114-324
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City | POTOMAC
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State | MD
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Zip | 20854-3976
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Country | US
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Telephone | 240-762-1279
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Fax |
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Authorized Official
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Title or Position | OWNER/CONSULTANT
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Name | SHUANNA TONI MONCRIEFFE
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Credential | MSCEM, NASM-CNC
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Telephone | 301-974-1425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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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 | 261QC1800X
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Taxonomy Name | Corporate Health 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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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