Provider Demographics
NPI:1104346006
Name:ALLWELL, CHARITY
Entity type:Individual
Prefix:
First Name:CHARITY
Middle Name:
Last Name:ALLWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7365 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:JESSUP
Mailing Address - State:MD
Mailing Address - Zip Code:20794-9456
Mailing Address - Country:US
Mailing Address - Phone:301-455-4116
Mailing Address - Fax:
Practice Address - Street 1:8101 SANDY SPRING RD STE 110
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-3596
Practice Address - Country:US
Practice Address - Phone:301-455-4116
Practice Address - Fax:240-554-2345
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR183253163WH0200X, 163WP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health