Provider Demographics
NPI:1730787847
Name:ENVISION HEALTH AND WELLNESS
Entity type:Organization
Organization Name:ENVISION HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMON-WATERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:443-867-7471
Mailing Address - Street 1:5122 CREST HAVEN WAY PERRY HALL MD 21128
Mailing Address - Street 2:
Mailing Address - City:PERRY HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21128
Mailing Address - Country:US
Mailing Address - Phone:443-867-7471
Mailing Address - Fax:
Practice Address - Street 1:2 W ROLLING XRDS STE 111
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-6211
Practice Address - Country:US
Practice Address - Phone:443-867-7471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty