Provider Demographics
NPI:1568772416
Name:WELLNESS FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:WELLNESS FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCCLURE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-257-9922
Mailing Address - Street 1:191 CLARK AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-3404
Mailing Address - Country:US
Mailing Address - Phone:802-257-9922
Mailing Address - Fax:802-258-3809
Practice Address - Street 1:191 CLARK AVE STE 1
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-3404
Practice Address - Country:US
Practice Address - Phone:802-257-9922
Practice Address - Fax:802-258-3809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty