Provider Demographics
NPI:1164206256
Name:PRAIRIE WELLNESS GROUP LLC
Entity Type:Organization
Organization Name:PRAIRIE WELLNESS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-771-4018
Mailing Address - Street 1:13510 NE 228TH CT
Mailing Address - Street 2:
Mailing Address - City:BRUSH PRAIRIE
Mailing Address - State:WA
Mailing Address - Zip Code:98606-4201
Mailing Address - Country:US
Mailing Address - Phone:360-771-4018
Mailing Address - Fax:
Practice Address - Street 1:13510 NE 228TH CT
Practice Address - Street 2:
Practice Address - City:BRUSH PRAIRIE
Practice Address - State:WA
Practice Address - Zip Code:98606-4201
Practice Address - Country:US
Practice Address - Phone:360-771-4018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty