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Contact Information

MAGNOLIA HEALTH CARE LLC
2407 BANEBERRY LN
GAMBRILLS, MD21054-1992
 Phone: 410-793-2634
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Wound Care

163WW0000X
 

Family

363LF0000X 50 Nurse Practitioner
Indicates primary specialty

NPI Profile & details for MAGNOLIA HEALTH CARE LLC

NPI # 1225908445
LBN Legal business name MAGNOLIA HEALTH CARE LLC
Authorized official SHAQUILLA VAZQUEZ CLARK - (OWNER)
Entity Organization
Organization subpart 1 Yes
Enumeration date 11/11/2025
Last updated 01/02/2026 - About 5 months ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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