Provider Demographics
NPI:1164204426
Name:SUNLIFE WELLNESS & HYDRATION, LLC
Entity Type:Organization
Organization Name:SUNLIFE WELLNESS & HYDRATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:HAAGENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:251-504-0925
Mailing Address - Street 1:11 N WATER ST FL 10
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36602-5010
Mailing Address - Country:US
Mailing Address - Phone:251-504-0925
Mailing Address - Fax:
Practice Address - Street 1:11 N WATER ST FL 10
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36602-5010
Practice Address - Country:US
Practice Address - Phone:251-402-1388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty