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WELLNESS LEGACY LLC
NPI 1992433916
Nurse Practitioner - Psychiatric/Mental Health in Towson, MD

Active since August 09, 2022
1016 DULANEY VALLEY RD, TOWSON, MD 21204(410) 286-1258 Get Directions Write a Review

NPPES record last updated: March 27, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Wellness Legacy Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WELLNESS LEGACY LLC (NPI 1992433916) is a healthcare organization registered as a psychiatric/mental health in Towson, Maryland and active in the NPI registry since August 2022. The organization lists Mark Anthony Bergonia Ison, Co -owner, as its authorized official.

NPPES Registry Identity

NPI1992433916
Entity TypeOrganization
Primary Taxonomy363LP0808X
Legal Business NameWELLNESS LEGACY LLC
Location Address1016 DULANEY VALLEY RDTowson, MD 21204-2702
Mailing Address1539 Blakes Legacy DrBel Air, MD 21014-1946 · (410) 286-1258 · Fax (443) 231-3684
Phone(410) 286-1258
Organization SubpartYes
Authorized OfficialMark Anthony Bergonia IsonCo -owner · (410) 286-1258
Enumeration DateAugust 9, 2022
Last NPPES UpdateMarch 27, 2024
NPPES CertifiedMarch 27, 2024
✔ NPI 1992433916 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
1016 DULANEY VALLEY RD, Towson, MD 21204
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Other Names 1

Doing Business AsWellness Legacy Llc

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ANNA CRESTA IBANEZ DECENA-TRINIDAD PMHNP
Nurse Practitioner (Psychiatric/Mental Health)
1016 DULANEY VALLEY RD
TOWSON, MD 21204
Baltimore County (410) 286-1258

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Wellness Legacy LLC's NPI number?

The NPI number for Wellness Legacy LLC is 1992433916. It was assigned to this organization in the NPPES registry on August 9, 2022.

Where is Wellness Legacy LLC located?

Wellness Legacy LLC is located at 1016 Dulaney Valley Rd, Towson, MD 21204. The listed phone number is (410) 286-1258.

What is Wellness Legacy LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

When was this NPI record last updated?

The NPPES record for Wellness Legacy LLC was last updated on March 27, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.