Provider Demographics
NPI:1619738424
Name:DUNDALK HEALTH & WELLNESS LLC
Entity Type:Organization
Organization Name:DUNDALK HEALTH & WELLNESS LLC
Other - Org Name:DUNDALK HEALTH & WELLNESS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-438-9532
Mailing Address - Street 1:6610 TRIBUTARY ST STE 310B
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-6514
Mailing Address - Country:US
Mailing Address - Phone:443-438-9532
Mailing Address - Fax:443-438-9852
Practice Address - Street 1:6610 TRIBUTARY ST STE 310B
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-6514
Practice Address - Country:US
Practice Address - Phone:443-438-9532
Practice Address - Fax:443-438-9852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty