Provider Demographics
NPI:1194601641
Name:NETTLE AND MOON WELLNESS LLC
Entity type:Organization
Organization Name:NETTLE AND MOON WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WADDELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN IBCLC
Authorized Official - Phone:443-227-5862
Mailing Address - Street 1:10450 SHAKER DR STE 108
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-2347
Mailing Address - Country:US
Mailing Address - Phone:443-227-5862
Mailing Address - Fax:
Practice Address - Street 1:10450 SHAKER DR STE 108
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2347
Practice Address - Country:US
Practice Address - Phone:443-227-5862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty