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General NPI Number Information
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NPI Number | 1578383626
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Entity Type | Organization
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Legal Business Name | IMMUNITY CARE LLC
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Dates
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Enumeration Date | 10/14/2024
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 750 MAIN ST FL 2
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City | REISTERSTOWN
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State | MD
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Zip | 21136-2515
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Country | US
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Telephone | 410-297-1601
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Fax | 443-285-0787
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Provider Business Mailing Address
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Address Line | 750 MAIN ST FL 2
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City | REISTERSTOWN
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State | MD
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Zip | 21136-2515
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Country | US
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Telephone | 410-297-1601
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Fax | 443-285-0787
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | MONAA WALTON
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Credential | CRNP-PMH
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Telephone | 443-936-9138
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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