Provider Demographics
NPI:1336948728
Name:PREMIER WELLNESS HEALTHCARE
Entity type:Organization
Organization Name:PREMIER WELLNESS HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DICARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-653-3933
Mailing Address - Street 1:103 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3539
Mailing Address - Country:US
Mailing Address - Phone:888-333-1345
Mailing Address - Fax:410-732-2025
Practice Address - Street 1:103 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3539
Practice Address - Country:US
Practice Address - Phone:888-333-1345
Practice Address - Fax:410-732-2025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty