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Organization
PAIN & WELLNESS THERAPIES LLC
Active
Organization
PAIN & WELLNESS THERAPIES LLC
Active
Other names
Pain & Wellness Therapies, Pain & Wellness Therapies
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LESLIE OGBEBOR AGACNP-BC (NURSE PRACTITIONER)
(301) 592-7642
Entity
Organization
Contact information
Practice address
2300 GARRISON BLVD STE 200, BALTIMORE, MD 21216-2309
(301) 592-7642
Mailing address
PO BOX 688, JESSUP, MD 20794-0688
Taxonomy
Speciality
Code
Description
License number
State
261QI0500X
Infusion Therapy Clinic/Center
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1851637094
—
MD
05
—
1922502319
—
MD
Enumeration date
10/17/2018
Last updated
04/10/2019
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