Provider Demographics
NPI:1841845351
Name:ADVANCED PRACTICE WELLNESS, LLC
Entity type:Organization
Organization Name:ADVANCED PRACTICE WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MERCEDES
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:CPNP
Authorized Official - Phone:404-635-6175
Mailing Address - Street 1:111 WASHINGTON GROVE LN UNIT 221
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON GROVE
Mailing Address - State:MD
Mailing Address - Zip Code:20880-7508
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:WASHINGTONIAN BLVD STE 550
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878
Practice Address - Country:US
Practice Address - Phone:240-230-7170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-02
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty