Individual
JUSTIN WILT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
4635 FOXVILLE RD, SABILLASVILLE, MD 21780-8510
(240) 367-6331
Mailing address
4635 FOXVILLE RD, SABILLASVILLE, MD 21780-8510
(240) 367-6331
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2023193496
MD
Other
Enumeration date
01/02/2024
Last updated
01/02/2024
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