Organization Name: | SOUTH MOUNTAIN WOMEN'S HEALTH CENTER LLC |
NPI Number: | 1932388493 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TRACEY GALLOWAY ELIZALDE (OWNER) |
Mailing Address: | 9 Saint Paul St 2nd Floor Boonsboro |
State: | MD US |
Postal Code: | 217131334 |
Phone Number: | 3014326897 |
Fax Number: | 3014326298 |
NPI Enumeration Date: | 10/31/2007 |
NPI Last Update Date: | 04/23/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R100650 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |