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General NPI Number Information
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NPI Number | 1750197661
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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 | 12/05/2024
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 9712 BELAIR RD STE 301
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City | NOTTINGHAM
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State | MD
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Zip | 21236-1113
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Country | US
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Telephone | 443-883-1826
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Fax |
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Provider Business Mailing Address
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Address Line | 9712 BELAIR RD STE 301
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City | NOTTINGHAM
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State | MD
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Zip | 21236-1113
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Country | US
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Telephone | 443-883-1826
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTIE SIMON-WATERMAN
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Credential | DNP, CRNP, PMHNP
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Telephone | 443-883-1826
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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