Provider Demographics
NPI:1558051805
Name:NEW LIFE HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:NEW LIFE HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC NP DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRANISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:203-305-3442
Mailing Address - Street 1:6224 FAYETTEVILLE RD STE 106A
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6288
Mailing Address - Country:US
Mailing Address - Phone:919-544-8889
Mailing Address - Fax:
Practice Address - Street 1:6224 FAYETTEVILLE RD STE 106A
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6288
Practice Address - Country:US
Practice Address - Phone:919-544-8889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty