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General NPI Number Information
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NPI Number | 1730787847
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Entity Type | Organization
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Legal Business Name | ENVISION HEALTH AND WELLNESS
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Dates
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Enumeration Date | 10/12/2020
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Last Update Date | 10/12/2020
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Provider Practice Location Address
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Address Line | 2 W ROLLING XRDS STE 111
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City | CATONSVILLE
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State | MD
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Zip | 21228-6211
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Country | US
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Telephone | 443-867-7471
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Fax |
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Provider Business Mailing Address
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Address Line | 5122 CREST HAVEN WAY PERRY HALL MD 21128
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City | PERRY HALL
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State | MD
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Zip | 21128
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Country | US
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Telephone | 443-867-7471
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Fax |
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Authorized Official
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Title or Position | OWNER/ PROVIDER
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Name | CHRISTIE SIMON-WATERMAN
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Credential | CRNP
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Telephone | 443-867-7471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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