Provider Demographics
NPI:1144413899
Name:WOMEN'S WELLNESS, LLC
Entity Type:Organization
Organization Name:WOMEN'S WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:F
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:435-674-1700
Mailing Address - Street 1:301 NORTH 200 EAST
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3040
Mailing Address - Country:US
Mailing Address - Phone:435-674-1700
Mailing Address - Fax:435-674-4681
Practice Address - Street 1:301 NORTH 200 EAST
Practice Address - Street 2:SUITE 2C
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3040
Practice Address - Country:US
Practice Address - Phone:435-674-1700
Practice Address - Fax:435-674-4681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1932229259261Q00000X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center