Provider Demographics
NPI:1013500362
Name:WINNERS HEALTH & WELLNESS LLC
Entity Type:Organization
Organization Name:WINNERS HEALTH & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:P
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:609-284-5354
Mailing Address - Street 1:8575 WINDOW LATCH WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-5637
Mailing Address - Country:US
Mailing Address - Phone:609-284-5354
Mailing Address - Fax:
Practice Address - Street 1:8575 WINDOW LATCH WAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5637
Practice Address - Country:US
Practice Address - Phone:609-284-5354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-18
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDPENDINGMedicaid