Provider Demographics
NPI:1043961816
Name:WELLNESS FOR LIFE
Entity Type:Organization
Organization Name:WELLNESS FOR LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTIONER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVECCHIO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:360-524-0111
Mailing Address - Street 1:708 COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-4111
Mailing Address - Country:US
Mailing Address - Phone:360-524-0111
Mailing Address - Fax:
Practice Address - Street 1:708 COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-4111
Practice Address - Country:US
Practice Address - Phone:360-524-0111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center