Provider Demographics
NPI:1649865064
Name:LYNXSURE WELLNESS CENTER LLC
Entity type:Organization
Organization Name:LYNXSURE WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:EDIRIN
Authorized Official - Middle Name:
Authorized Official - Last Name:UWAYZOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-253-5509
Mailing Address - Street 1:7652 BELAIR RD STE A
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4067
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7323 HANOVER PKWY STE A
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3617
Practice Address - Country:US
Practice Address - Phone:301-477-3676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LYNXSURE WELLNESS CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty