WELLNESS SOURCE LLC NPI 1780031724

NPI Information

NPI: 1780031724
Provider Name: WELLNESS SOURCE LLC

Doing Business As: YOUR WELLNESS SOURCES

Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

Address:
4301 GARDEN CITY DR STE 304
HYATTSVILLE, MD
ZIP 20785
Phone: (301) 235-0060
Get Directions

WELLNESS SOURCE LLC is a family nurse practitioner in Hyattsville, MD. WELLNESS SOURCE LLC NPI is 1780031724. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Your Wellness Sources.

The provider's business location address is:

4301 GARDEN CITY DR STE 304
HYATTSVILLE, MD
ZIP 20785-105
Phone: (301) 235-0060
Fax: (240) 324-7720

The provider's authorized official is Marshalee George .
The authorized official title is Medical Director and has the following contact phone number (301) 235-0060.

The enumeration date for this NPI number is 5/19/2016 and was last updated on 3/8/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	2084P0800X	Psychiatry & Neurology	Psychiatry	No
2	2084P0802X	Psychiatry & Neurology	Addiction Psychiatry	No
3	261QP2300X	Clinic/Center	Primary Care	No
4	363LF0000X	Nurse Practitioner	Family	Yes
5	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	No
6	364SP0809X	Clinical Nurse Specialist	Psychiatric/Mental Health, Adult	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	051747821	MEDICAID	DISTRICT OF COLUMBIA
2	600082700	MEDICAID	MARYLAND
3	540582	OTHER	MARYLAND	MEDICARE PTAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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