Provider Demographics
NPI:1619578168
Name:EDGEWELLNESS LLC &NURSING SERVICES
Entity Type:Organization
Organization Name:EDGEWELLNESS LLC &NURSING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE
Authorized Official - Prefix:MR
Authorized Official - First Name:GODWIN
Authorized Official - Middle Name:N
Authorized Official - Last Name:NWOHA
Authorized Official - Suffix:
Authorized Official - Credentials:ACCOUNTANT
Authorized Official - Phone:443-453-7412
Mailing Address - Street 1:6 SECRETARIAT CT
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-6155
Mailing Address - Country:US
Mailing Address - Phone:443-453-7412
Mailing Address - Fax:
Practice Address - Street 1:7416 HARFORD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-7152
Practice Address - Country:US
Practice Address - Phone:443-794-1039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty