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General NPI Number Information
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NPI Number | 1477204345
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Entity Type | Organization
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Legal Business Name | HYDROFIX- IV & WELLNESS CENTER
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Dates
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Enumeration Date | 01/12/2022
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Last Update Date | 01/12/2022
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Provider Practice Location Address
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Address Line | 13711 OLD ANNAPOLIS ROAD
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City | BOWIE
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State | MD
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Zip | 20720-2072
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Country | US
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Telephone | 301-786-5900
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Fax | 301-850-4310
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Provider Business Mailing Address
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Address Line | 5602 LAKE SPRING CT STE 102A
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City | BOWIE
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State | MD
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Zip | 20720-3817
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Country | US
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Telephone | 301-786-5900
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Fax | 301-850-4310
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MRS. EMMERENCIA MORFAW
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Credential | NP
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Telephone | 124-053-5767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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