Provider Demographics
NPI:1477204345
Name:HYDROFIX- IV & WELLNESS CENTER
Entity Type:Organization
Organization Name:HYDROFIX- IV & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMMERENCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORFAW
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:124-053-5767
Mailing Address - Street 1:5602 LAKE SPRING CT STE 102A
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-3817
Mailing Address - Country:US
Mailing Address - Phone:301-786-5900
Mailing Address - Fax:301-850-4310
Practice Address - Street 1:13711 OLD ANNAPOLIS ROAD
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-2072
Practice Address - Country:US
Practice Address - Phone:301-786-5900
Practice Address - Fax:301-850-4310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty