Provider Demographics
NPI:1558923672
Name:OC WELLNESS LLC
Entity Type:Organization
Organization Name:OC WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KEESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLDEN-WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:443-944-9245
Mailing Address - Street 1:1410 S SALISBURY BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-7131
Mailing Address - Country:US
Mailing Address - Phone:443-944-9245
Mailing Address - Fax:
Practice Address - Street 1:1410 S SALISBURY BLVD UNIT 1
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801
Practice Address - Country:US
Practice Address - Phone:443-380-4565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-28
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty