Provider Demographics
NPI:1316544844
Name:THE WELLNESS CONNECTION LLC
Entity Type:Organization
Organization Name:THE WELLNESS CONNECTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FORD PETERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:602-679-4228
Mailing Address - Street 1:83 N AMBER CT
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-5726
Mailing Address - Country:US
Mailing Address - Phone:602-679-4228
Mailing Address - Fax:
Practice Address - Street 1:83 N AMBER CT
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-5726
Practice Address - Country:US
Practice Address - Phone:602-679-4228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-07
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty