Provider Demographics
NPI:1144901315
Name:THESELAH WELLNESS LLC
Entity type:Organization
Organization Name:THESELAH WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DNP
Authorized Official - Prefix:DR
Authorized Official - First Name:KALU
Authorized Official - Middle Name:
Authorized Official - Last Name:OKORIE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:480-360-1002
Mailing Address - Street 1:16416 W DESERT MIRAGE DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388-5491
Mailing Address - Country:US
Mailing Address - Phone:480-360-1002
Mailing Address - Fax:
Practice Address - Street 1:16416 W DESERT MIRAGE DR
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85388-5491
Practice Address - Country:US
Practice Address - Phone:480-360-1002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty