Provider Demographics
NPI:1841764057
Name:NOURISHING LIFE WELLNESS, LLC
Entity Type:Organization
Organization Name:NOURISHING LIFE WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:KIM-KHANH
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, DOM, DIPLOM
Authorized Official - Phone:443-312-9560
Mailing Address - Street 1:7300 GRACE DR STE A
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2473
Mailing Address - Country:US
Mailing Address - Phone:443-312-9560
Mailing Address - Fax:
Practice Address - Street 1:7300 GRACE DR # 1A
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2473
Practice Address - Country:US
Practice Address - Phone:443-312-9560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-22
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty