=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619634292
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DOXA HEALTH AND WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2021
-----------------------------------------------------
Last Update Date | 11/18/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12800 LEDO CREEK TER
-----------------------------------------------------
City | BELTSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20705-5106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-329-5522
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12800 LEDO CREEK TER
-----------------------------------------------------
City | BELTSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20705-5106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-688-2517
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHIATRIC NURSE PRACTITIONER
-----------------------------------------------------
Name | MRS. ANDINWE NAMANGA
-----------------------------------------------------
Credential | CRNP-PMH
-----------------------------------------------------
Telephone | 240-688-2517
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------