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General NPI Number Information
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NPI Number | 1588552640
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Entity Type | Organization
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Legal Business Name | HOLISTIC REPRODUCTIVE WELLNESS GROUP
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Dates
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Enumeration Date | 06/26/2025
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 2806 BREWERS CROSSING WAY
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City | HANOVER
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State | MD
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Zip | 21076-2902
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Country | US
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Telephone | 480-242-1736
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Fax |
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Provider Business Mailing Address
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Address Line | 3030 GREENMOUNT AVE STE 300
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City | BALTIMORE
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State | MD
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Zip | 21218-6907
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Country | US
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Telephone | 410-870-9567
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Fax | 949-864-3194
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | AASTASSHIA LYNN LACY
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Credential | NP
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Telephone | 410-870-9567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number |
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License Number State |
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