Organization
PROACTIVE WELLNESSNP
Active
Other names
Proactive Wellness NP
Organization subpart
No
Provider details
NPI number
Authorized official
KONDI WALTERSSMITH CRNP (CEO/ NURSE PRACTITIONER)
(301) 741-0307
Entity
Organization
Contact information
Practice address
12114 BLUE FLAG WAY, COLUMBIA, MD 21044
(301) 741-0307
Mailing address
12114 BLUE FLAG WAY, COLUMBIA, MD 21044
(301) 741-0307
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
261QR0800X
Recovery Care Clinic/Center
—
—
Other
Enumeration date
06/26/2023
Last updated
12/06/2023
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