Provider Demographics
NPI:1275230757
Name:EMPOWERING WELLNESS
Entity Type:Organization
Organization Name:EMPOWERING WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-NP
Authorized Official - Phone:316-358-0025
Mailing Address - Street 1:439 N MCLEAN BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-5900
Mailing Address - Country:US
Mailing Address - Phone:316-358-0025
Mailing Address - Fax:316-776-4554
Practice Address - Street 1:439 N MCLEAN BLVD STE 204
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-5900
Practice Address - Country:US
Practice Address - Phone:316-358-0025
Practice Address - Fax:316-776-4554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center