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General NPI Number Information
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NPI Number | 1598112922
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Entity Type | Organization
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Legal Business Name | AU FAIT WELLNESS SERVICES LLC
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Dates
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Enumeration Date | 05/16/2016
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Last Update Date | 08/09/2016
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Provider Practice Location Address
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Address Line | 7708 OLD ALEXANDRIA FERRY RD
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City | CLINTON
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State | MD
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Zip | 20735-1872
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Country | US
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Telephone | 717-848-6998
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1977
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City | WALDORF
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State | MD
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Zip | 20604-1977
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HEATHER WALLICK
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Credential |
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Telephone | 202-277-3004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | R207551
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License Number State | MD
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