# WELLNESS LEGACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Wellness Legacy LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134777576
- **Authorized official:** MR. MARK ISON CRNP (CO-OWNER)
- **Authorized official phone:** (410) 286-1258

## Contact information

- **Practice address:** 260 GATEWAY DR STE 13, BEL AIR, MD 21014-4268
- **Practice address phone:** (410) 286-1258
- **Mailing address:** 1539 BLAKES LEGACY DR, BEL AIR, MD 21014-1946
- **Mailing address phone:** (817) 319-6878
- **Mailing address fax:** (443) 231-3684

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 08/28/2019
- **Last updated:** 03/27/2024