Provider Demographics
NPI:1568132777
Name:ROWAN HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:ROWAN HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:JINEAN
Authorized Official - Last Name:NIXON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:980-432-1090
Mailing Address - Street 1:1074 WOOD CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:CHINA GROVE
Mailing Address - State:NC
Mailing Address - Zip Code:28023-5671
Mailing Address - Country:US
Mailing Address - Phone:704-699-8404
Mailing Address - Fax:
Practice Address - Street 1:417 N MAIN ST STE F
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-4358
Practice Address - Country:US
Practice Address - Phone:980-432-1090
Practice Address - Fax:704-471-3016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-18
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1902467178Medicaid
NC1215603949Medicaid
NC1083936710Medicaid