Provider Demographics
NPI:1619503760
Name:NURTURING WELLNESS PEDIATRICS, PLLC
Entity Type:Organization
Organization Name:NURTURING WELLNESS PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:MELISSA
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-952-0293
Mailing Address - Street 1:5119 FOUNTAINBLUE DR
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-8893
Mailing Address - Country:US
Mailing Address - Phone:401-952-0293
Mailing Address - Fax:
Practice Address - Street 1:1500 INTERCHANGE AVE STE 200
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-2084
Practice Address - Country:US
Practice Address - Phone:401-952-0293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-20
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty