Provider Demographics
NPI:1710658307
Name:360 HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:360 HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP-C
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:540-360-1077
Mailing Address - Street 1:5570 RICHMOND RD BSMT SUITE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:VA
Mailing Address - Zip Code:22974-4421
Mailing Address - Country:US
Mailing Address - Phone:540-360-1077
Mailing Address - Fax:434-484-1919
Practice Address - Street 1:5570 RICHMOND RD BSMT SUITE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:VA
Practice Address - Zip Code:22974-4421
Practice Address - Country:US
Practice Address - Phone:540-360-1077
Practice Address - Fax:434-484-1919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty