Provider Demographics
NPI:1003321480
Name:NOURISH WELLNESS PLLC
Entity Type:Organization
Organization Name:NOURISH WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:
Authorized Official - First Name:YAMILETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CAZORLA-LANCASTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-969-4106
Mailing Address - Street 1:PO BOX 20968
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4106
Mailing Address - Country:US
Mailing Address - Phone:509-969-6214
Mailing Address - Fax:888-565-2493
Practice Address - Street 1:3105 SUMMITVIEW AVE STE C
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-2310
Practice Address - Country:US
Practice Address - Phone:509-969-6214
Practice Address - Fax:888-565-2493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60077117208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty