Provider Demographics
NPI:1760148290
Name:WEVOLVE
Entity Type:Organization
Organization Name:WEVOLVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:475-202-3318
Mailing Address - Street 1:4 CORPORATE DR STE 396
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-6266
Mailing Address - Country:US
Mailing Address - Phone:475-202-3450
Mailing Address - Fax:203-712-7130
Practice Address - Street 1:4 CORPORATE DR STE 396
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-6266
Practice Address - Country:US
Practice Address - Phone:475-202-3450
Practice Address - Fax:203-712-7130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty