Provider Demographics
NPI:1407289820
Name:WELLNESS INSTITUTE OF TEXAS
Entity Type:Organization
Organization Name:WELLNESS INSTITUTE OF TEXAS
Other - Org Name:WIT
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO/ PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROCHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:NICOLAS-WEDIGE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:210-641-3335
Mailing Address - Street 1:14855 BLANCO RD STE 400
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-7731
Mailing Address - Country:US
Mailing Address - Phone:210-641-3335
Mailing Address - Fax:210-568-6101
Practice Address - Street 1:14855 BLANCO RD STE 400
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-7731
Practice Address - Country:US
Practice Address - Phone:210-641-3335
Practice Address - Fax:210-568-6101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-21
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX713314363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1164750410OtherNPI INDIVIDUAL PRACTITIONERS