Provider Demographics
NPI:1356008742
Name:ENHANCED WELLNESS LLC
Entity Type:Organization
Organization Name:ENHANCED WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:844-770-0404
Mailing Address - Street 1:12425 OLD MERIDIAN ST STE B3
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-8725
Mailing Address - Country:US
Mailing Address - Phone:844-770-0404
Mailing Address - Fax:
Practice Address - Street 1:12425 OLD MERIDIAN ST STE B3
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-8725
Practice Address - Country:US
Practice Address - Phone:844-770-0404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-20
Last Update Date:2021-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty