Organization · Type 2 NPI

Revered-Holistic Healthcare LLC

Family Nurse Practitioner · Columbia, MD

NPI number 1700377876 Active

Practice location

9861 Broken Land Pkwy Ste 100
Columbia, MD 21046-3031

Call (443) 621-2203 Map

Fax (410) 381-0216

Mailing address

4218 Summer Shade Way
Owings Mills, MD 21117-4872

Specialties and licenses

Taxonomy	Code	License
Family Nurse Practitioner Primary	363LF0000X	R194691 (MD)

Family Nurse Practitioner: Definition to come...

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NPI record

NPI: 1700377876
Entity type: Organization (Type 2)
Issued: May 24, 2018
Last updated: Sep 11, 2025
Status: Active

Other names

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Revered Holistic Healthcare LLC · doing business as
Revered Holistic Healthcare LLC · doing business as

Authorized official

Adetutu Awodipe, FNP
Owner
(443) 621-2203

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1700377876

Revered-Holistic Healthcare LLC's National Provider Identifier is 1700377876, issued on May 24, 2018. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in Columbia, MD. The record was last updated on Sep 11, 2025.