Provider Demographics
NPI:1669023974
Name:FAIR WINDS WELLNESS LLC
Entity Type:Organization
Organization Name:FAIR WINDS WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NUTHALL
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:410-228-2474
Mailing Address - Street 1:417 ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-1958
Mailing Address - Country:US
Mailing Address - Phone:410-228-2474
Mailing Address - Fax:
Practice Address - Street 1:417 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-1958
Practice Address - Country:US
Practice Address - Phone:410-228-2474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service