Provider Demographics
NPI:1679017933
Name:WELLSPRING WOMEN'S HEALTH LLC
Entity Type:Organization
Organization Name:WELLSPRING WOMEN'S HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLIS
Authorized Official - Suffix:
Authorized Official - Credentials:CNM WHNP
Authorized Official - Phone:908-745-9178
Mailing Address - Street 1:280 ROLLING KNOLLS WAY
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-1915
Mailing Address - Country:US
Mailing Address - Phone:908-745-9178
Mailing Address - Fax:732-626-6579
Practice Address - Street 1:1814 E 2ND ST
Practice Address - Street 2:
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076-1751
Practice Address - Country:US
Practice Address - Phone:732-456-6262
Practice Address - Fax:732-626-6579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00343800363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty