Provider Demographics
NPI:1578318598
Name:MEADOWLARK MIND & BODY LLC
Entity Type:Organization
Organization Name:MEADOWLARK MIND & BODY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PROVIDER SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:SHEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:BSHA
Authorized Official - Phone:402-898-1113
Mailing Address - Street 1:913 CENTER ST STE 1
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-3400
Mailing Address - Country:US
Mailing Address - Phone:307-300-5885
Mailing Address - Fax:
Practice Address - Street 1:913 CENTER ST STE 1
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-3400
Practice Address - Country:US
Practice Address - Phone:307-300-5885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty