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Organization
WELLNESS LEGACY LLC
Active
Organization
WELLNESS LEGACY LLC
Active
Other names
Wellness Legacy LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK ISON CRNP (CO-OWNER)
(410) 286-1258
Entity
Organization
Contact information
Practice address
260 GATEWAY DR STE 13, BEL AIR, MD 21014-4268
(410) 286-1258
Mailing address
1539 BLAKES LEGACY DR, BEL AIR, MD 21014-1946
(817) 319-6878
(443) 231-3684
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
08/28/2019
Last updated
03/27/2024
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