Provider Demographics
NPI:1750197661
Name:ENVISION HEALTH AND WELLNESS
Entity type:Organization
Organization Name:ENVISION HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMON-WATERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, CRNP, PMHNP
Authorized Official - Phone:443-883-1826
Mailing Address - Street 1:9712 BELAIR RD STE 301
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-1113
Mailing Address - Country:US
Mailing Address - Phone:443-883-1826
Mailing Address - Fax:
Practice Address - Street 1:9712 BELAIR RD STE 301
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-1113
Practice Address - Country:US
Practice Address - Phone:443-883-1826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-05
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty