Provider Demographics
NPI:1417605577
Name:PHOENIX HEALTH & WELLNESS PLLC
Entity Type:Organization
Organization Name:PHOENIX HEALTH & WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-C
Authorized Official - Phone:509-581-3550
Mailing Address - Street 1:816 W FRANCIS AVE # 502
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-6512
Mailing Address - Country:US
Mailing Address - Phone:509-581-3550
Mailing Address - Fax:509-232-3309
Practice Address - Street 1:5920 N BRIDGET ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-7062
Practice Address - Country:US
Practice Address - Phone:509-581-3550
Practice Address - Fax:509-232-3309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-16
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care