Provider Demographics
NPI:1477204550
Name:WELL INFUSED, LLC
Entity Type:Organization
Organization Name:WELL INFUSED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STACI
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLUME
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-674-8857
Mailing Address - Street 1:14297 BERGEN BLVD STE 125
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-3420
Mailing Address - Country:US
Mailing Address - Phone:317-674-8857
Mailing Address - Fax:
Practice Address - Street 1:14297 BERGEN BLVD STE 125
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-3420
Practice Address - Country:US
Practice Address - Phone:317-674-8857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEGACY IMPACT HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-11
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service