Provider Demographics
NPI:1013539568
Name:WINGFOOT WELLNESS & HORMONES LLC
Entity Type:Organization
Organization Name:WINGFOOT WELLNESS & HORMONES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER/FNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:AMADO
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:480-590-6691
Mailing Address - Street 1:2500 S POWER ROAD
Mailing Address - Street 2:BUILDING 7 SUITE 218
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209
Mailing Address - Country:US
Mailing Address - Phone:480-590-6691
Mailing Address - Fax:480-393-8442
Practice Address - Street 1:2500 S POWER ROAD
Practice Address - Street 2:BUILDING 7 SUITE 218
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209
Practice Address - Country:US
Practice Address - Phone:480-590-6691
Practice Address - Fax:480-393-8442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty