Provider Demographics
NPI:1538747068
Name:FMW MEDSPA INC.
Entity type:Organization
Organization Name:FMW MEDSPA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:LINETTE
Authorized Official - Middle Name:I
Authorized Official - Last Name:EKE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:443-840-9478
Mailing Address - Street 1:1518 PHILADELPHIA RD
Mailing Address - Street 2:
Mailing Address - City:JOPPA
Mailing Address - State:MD
Mailing Address - Zip Code:21085-3216
Mailing Address - Country:US
Mailing Address - Phone:443-840-9478
Mailing Address - Fax:410-616-9048
Practice Address - Street 1:1518 PHILADELPHIA RD
Practice Address - Street 2:
Practice Address - City:JOPPA
Practice Address - State:MD
Practice Address - Zip Code:21085-3216
Practice Address - Country:US
Practice Address - Phone:443-840-9478
Practice Address - Fax:410-616-9048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-29
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)