Provider Demographics
NPI:1902324130
Name:FREE STATE HEALTH AND WELLNESS, LLC
Entity Type:Organization
Organization Name:FREE STATE HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:440-570-9428
Mailing Address - Street 1:100 MIDDLETOWN PKWY UNIT 202
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21769-7767
Mailing Address - Country:US
Mailing Address - Phone:240-647-9049
Mailing Address - Fax:
Practice Address - Street 1:43 COMMUNITY PL
Practice Address - Street 2:
Practice Address - City:CROWNSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21032-2034
Practice Address - Country:US
Practice Address - Phone:440-570-9428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-08
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty