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Organization
HEALTH RELEAF LLC
Active
Organization
HEALTH RELEAF LLC
Active
Other names
Self
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA BOATMAN (CREDENTIALING MANAGER)
(301) 399-6874
Entity
Organization
Contact information
Practice address
1406B CRAIN HWY S STE 304, GLEN BURNIE, MD 21061-4094
(301) 804-0344
Mailing address
1406B CRAIN HWY S STE 304, GLEN BURNIE, MD 21061-4094
(301) 804-0344
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/03/2021
Last updated
12/19/2022
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