Provider Demographics
NPI:1073814851
Name:AWAKEN WELLNESS, LLC
Entity Type:Organization
Organization Name:AWAKEN WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSE ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:STUKEY
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:410-312-9922
Mailing Address - Street 1:7130 MINSTREL WAY STE 160
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-5336
Mailing Address - Country:US
Mailing Address - Phone:410-312-9922
Mailing Address - Fax:
Practice Address - Street 1:7130 MINSTREL WAY STE 160
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5336
Practice Address - Country:US
Practice Address - Phone:410-312-9922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty