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General NPI Number Information
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NPI Number | 1831560143
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Entity Type | Organization
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Legal Business Name | GLOW WELLNESS LLC
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Dates
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Enumeration Date | 10/13/2015
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Last Update Date | 10/13/2015
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Provider Practice Location Address
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Address Line | 6500 SEVEN LOCKS RD SUITE 232
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City | CABIN JOHN
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State | MD
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Zip | 20818-1300
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Country | US
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Telephone | 202-510-1525
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Fax |
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Provider Business Mailing Address
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Address Line | 6500 SEVEN LOCKS RD SUITE 232
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City | CABIN JOHN
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State | MD
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Zip | 20818-1300
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Country | US
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Telephone | 202-510-1525
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | SIMONE HUDSON
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Credential |
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Telephone | 202-510-1525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | U01889
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License Number State | MD
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