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NPI Code Detail

MEDICARE: REVERED-HOLISTIC HEALTHCARE LLC

MEDICARE: REVERED-HOLISTIC HEALTHCARE LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerR194691MD

General Provider Information

NPI Number : 1700377876
Entity Type Code : Organization
Provider Name (Legal Business Name) : REVERED-HOLISTIC HEALTHCARE LLC
Provider Business Mailing Address
First Line : 4218 SUMMER SHADE WAY
Second Line :
City : OWINGS MILLS
State : MD
Zip : 21117-4872
Country : US
Telephone Number : 443-621-2203
Fax Number :
Provider Business Practice Location Address
First Line : 9861 BROKEN LAND PKWY STE 100
Second Line :
City : COLUMBIA
State : MD
Zip : 21046-3031
Country : US
Telephone Number : 443-621-2203
Fax Number : 410-381-0216
Authorized Official
Title or Position : OWNER
Name : ADETUTU AWODIPE
Credential : FNP
Telephone Number : 443-621-2203
Provider Enumeration Date : 05/24/2018
Last Update Date : 09/11/2025

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Directions to “REVERED-HOLISTIC HEALTHCARE LLC ” Practice Location

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