Provider Demographics
NPI:1073211959
Name:LIFELINE FAMILY HEALTH & WELLNESS, PLLC
Entity Type:Organization
Organization Name:LIFELINE FAMILY HEALTH & WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SHUNKEETHA
Authorized Official - Middle Name:LATRICE
Authorized Official - Last Name:TOTSCH
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:469-384-7781
Mailing Address - Street 1:5900 BALCONES DR STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4298
Mailing Address - Country:US
Mailing Address - Phone:214-641-0218
Mailing Address - Fax:
Practice Address - Street 1:9330 POPPY DR STE 500
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-4612
Practice Address - Country:US
Practice Address - Phone:469-384-7781
Practice Address - Fax:469-277-3000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-20
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1154734010OtherOWNER NPI