Provider Demographics
NPI:1750685178
Name:WELLNESS I NURSE PRACTITIONER IN FAMILY HEALTH, P.C.
Entity Type:Organization
Organization Name:WELLNESS I NURSE PRACTITIONER IN FAMILY HEALTH, P.C.
Other - Org Name:WELLNESS I
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALO
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:845-638-4574
Mailing Address - Street 1:337 N MAIN ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-4310
Mailing Address - Country:US
Mailing Address - Phone:845-638-4574
Mailing Address - Fax:845-638-9436
Practice Address - Street 1:337 N MAIN ST
Practice Address - Street 2:SUITE 6
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-4310
Practice Address - Country:US
Practice Address - Phone:845-638-4574
Practice Address - Fax:845-638-9436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334278363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty