Provider Demographics
NPI:1164148011
Name:NU VITALITY HYDRATION AND WELLNESS
Entity Type:Organization
Organization Name:NU VITALITY HYDRATION AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP-C
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHISHOLM
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:954-998-1131
Mailing Address - Street 1:2719 HOLLYWOOD BLVD # L-12
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-4821
Mailing Address - Country:US
Mailing Address - Phone:954-852-6954
Mailing Address - Fax:
Practice Address - Street 1:2719 HOLLYWOOD BLVD # L-12
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-4821
Practice Address - Country:US
Practice Address - Phone:954-852-6954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-12
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care