Provider Demographics
NPI:1245654649
Name:ATLANTIS WELLNESS
Entity type:Organization
Organization Name:ATLANTIS WELLNESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CRNP/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ASPINWALL
Authorized Official - Last Name:MILLETT
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:301-525-2013
Mailing Address - Street 1:9213 KENSINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6703
Mailing Address - Country:US
Mailing Address - Phone:301-525-2013
Mailing Address - Fax:301-960-4830
Practice Address - Street 1:9213 KENSINGTON PKWY
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6703
Practice Address - Country:US
Practice Address - Phone:301-525-2013
Practice Address - Fax:301-960-4830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR129024261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD416242100Medicaid