Provider Demographics
NPI:1174149686
Name:GOLDLINE HEALTH AND WELLNESS LLC
Entity type:Organization
Organization Name:GOLDLINE HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:GOLD
Authorized Official - Middle Name:E
Authorized Official - Last Name:OKOEKA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PMHNP
Authorized Official - Phone:401-433-9451
Mailing Address - Street 1:750 EAST AVE LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-6245
Mailing Address - Country:US
Mailing Address - Phone:401-433-9451
Mailing Address - Fax:
Practice Address - Street 1:750 EAST AVE LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-6245
Practice Address - Country:US
Practice Address - Phone:401-433-9451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-20
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty