MEDICARE: MAGNOLIA FAMILY HEALTH 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
1	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1972103661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGNOLIA FAMILY HEALTH LLC

Provider Business Mailing Address
First Line	:	121 E 1ST AVE
Second Line	:
City	:	OAKLAND
State	:	MD
Zip	:	21550-2728
Country	:	US
Telephone Number	:	301-759-3800
Fax Number	:	301-777-7455

Provider Business Practice Location Address
First Line	:	121 E 1ST AVE # AVW
Second Line	:
City	:	OAKLAND
State	:	MD
Zip	:	21550-2728
Country	:	US
Telephone Number	:	301-759-3800
Fax Number	:	301-777-7455

Authorized Official
Title or Position	:	OWNER
Name	:	FAITH ANN RODEHEAVER
Credential	:	CRNP
Telephone Number	:	301-759-3800

Provider Enumeration Date	:	10/30/2020
Last Update Date	:	10/21/2025

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