Provider Demographics
NPI:1083358378
Name:RENEWED HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:RENEWED HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:AWILDA
Authorized Official - Middle Name:ALTAGRACIA
Authorized Official - Last Name:LUGO MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:203-510-1187
Mailing Address - Street 1:615 W JOHNSON AVE STE 202-1061
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-4531
Mailing Address - Country:US
Mailing Address - Phone:475-377-0887
Mailing Address - Fax:806-454-5698
Practice Address - Street 1:615 W JOHNSON AVE STE 202-1061
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-4531
Practice Address - Country:US
Practice Address - Phone:475-377-0887
Practice Address - Fax:806-454-5698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-23
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty