Manifest Wellness Services LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

MANIFEST WELLNESS SERVICES LLC

Practice address

2201 Eastern Blvd Ste a
Middle River, MD 21220-4296

Phone

(410) 774-6769

Fax

(443) 596-0057

NPI assigned

Mar 13, 2024

Organization subpart

No

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

Authorized official

Name

Genevieve Ifeanyichukwu

Title

Chief Executive Officer

Phone

(443) 531-4264

Specialties & licenses 1

Addresses

Other names 1

• MANIFEST WEIGHT LOSS: LOSE WEIGHT, LOVE LIFE, NO RESTRICTIONS. Doing business as

Locations

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

{
    "created_epoch": "1710288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781222400000",
    "number": "1851150833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 EASTERN AVE APT A",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212313734",
            "telephone_number": "410-774-6769",
            "fax_number": "443-596-0057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 EASTERN BLVD STE A",
            "city": "MIDDLE RIVER",
            "state": "MD",
            "postal_code": "212204296",
            "telephone_number": "410-774-6769",
            "fax_number": "443-596-0057"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6340 Security Blvd Ste B16",
            "address_purpose": "LOCATION",
            "city": "Woodlawn",
            "state": "MD",
            "postal_code": "212075173",
            "country_code": "US",
            "telephone_number": "443-531-4264",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MANIFEST WELLNESS SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-13",
        "last_updated": "2026-06-12",
        "certification_date": "2026-06-12",
        "status": "A",
        "authorized_official_last_name": "IFEANYICHUKWU",
        "authorized_official_first_name": "GENEVIEVE",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "443-531-4264"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MANIFEST WEIGHT LOSS: LOSE WEIGHT, LOVE LIFE, NO RESTRICTIONS.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Nurse Practitioner in Middle River, MD
• Providers in Middle River, MD by specialty
• Family Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2026; 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.