Provider Demographics
NPI:1235475088
Name:NEW LEAF WELLNESS
Entity Type:Organization
Organization Name:NEW LEAF WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:ART
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-252-2932
Mailing Address - Street 1:12129 UNIVERSITY AVE STE 1500
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8287
Mailing Address - Country:US
Mailing Address - Phone:515-657-6210
Mailing Address - Fax:515-657-6208
Practice Address - Street 1:12129 UNIVERSITY AVE STE 1500
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8287
Practice Address - Country:US
Practice Address - Phone:515-657-6210
Practice Address - Fax:515-657-6208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01554208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty