Provider Demographics
NPI:1447744321
Name:WELLNESS PROXY RESOURCES, LLC
Entity Type:Organization
Organization Name:WELLNESS PROXY RESOURCES, LLC
Other - Org Name:WELLNESS PROXY RESOURCES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLO
Authorized Official - Middle Name:NAKUWEZA
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:469-907-1099
Mailing Address - Street 1:1833 W HUNT ST BLDG B
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-3367
Mailing Address - Country:US
Mailing Address - Phone:469-907-1099
Mailing Address - Fax:469-907-1055
Practice Address - Street 1:1833 W HUNT ST BLDG B
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-3367
Practice Address - Country:US
Practice Address - Phone:469-907-1099
Practice Address - Fax:469-907-1055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-14
Last Update Date:2020-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX867312251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based