Provider Demographics
NPI:1851001259
Name:HEALTH WELLNESS PACK
Entity Type:Organization
Organization Name:HEALTH WELLNESS PACK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:DAPHENE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTEMA-JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RDN,MBA,MPH
Authorized Official - Phone:443-285-1454
Mailing Address - Street 1:6127 JERRYS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3824
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6127 JERRYS DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3824
Practice Address - Country:US
Practice Address - Phone:443-285-1454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDDX5601OtherRDN LICENSE