Provider Demographics
NPI:1033996673
Name:MOUNTAIN VIEW WELLNESS, LLC
Entity Type:Organization
Organization Name:MOUNTAIN VIEW WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:BAULER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:240-738-0954
Mailing Address - Street 1:PO BOX 122
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21750-0122
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:117 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MD
Practice Address - Zip Code:21750-1416
Practice Address - Country:US
Practice Address - Phone:240-738-0953
Practice Address - Fax:301-238-7386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR229244OtherCRNP
WVAPRN97594OtherAPRN-CNP