NPIMap

Organization Active NPI

Health Releaf LLC

Doing business as Self

  • Psychiatric/Mental Health Nurse Practitioner
  • Glen Burnie, MD
National Provider Identifier
1770255291
Registry record updated Dec 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
HEALTH RELEAF LLC
Doing business as
Self
Practice address
1406B Crain Hwy S Ste 304
Glen Burnie, MD 21061-4094
Phone
(301) 804-0344
NPI assigned
Oct 3, 2021
Last updated
Dec 19, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Donna Boatman
Title
Credentialing Manager
Phone
(301) 399-6874

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU Primary

Addresses

Primary practice location

1406B Crain Hwy S Ste 304
Glen Burnie, MD 21061-4094

Mailing address

1406B Crain Hwy S Ste 304
Glen Burnie, MD 21061-4094
Phone (301) 804-0344

Other identifiers 1

IdentifierTypeStateIssuer
633004500MedicaidMD

Other names 1

  • Self Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Health Releaf LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1633219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671408000000",
    "number": "1770255291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1406B CRAIN HWY S STE 304",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210614094",
            "telephone_number": "301-804-0344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1406B CRAIN HWY S STE 304",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210614094",
            "telephone_number": "301-804-0344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTH RELEAF LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-03",
        "last_updated": "2022-12-19",
        "certification_date": "2022-12-19",
        "status": "A",
        "authorized_official_last_name": "BOATMAN",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "301-399-6874"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "633004500",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Self",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Self",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glen Burnie, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.