Provider Demographics
NPI:1760160865
Name:OLU WELLNESS, LLC
Entity Type:Organization
Organization Name:OLU WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAE LYNNE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWPHER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:808-430-0794
Mailing Address - Street 1:16-590 OLD VOLCANO RD STE B
Mailing Address - Street 2:
Mailing Address - City:KEAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96749-8158
Mailing Address - Country:US
Mailing Address - Phone:808-430-0794
Mailing Address - Fax:808-930-4721
Practice Address - Street 1:16-590 OLD VOLCANO RD STE B
Practice Address - Street 2:
Practice Address - City:KEAAU
Practice Address - State:HI
Practice Address - Zip Code:96749-8158
Practice Address - Country:US
Practice Address - Phone:808-430-0794
Practice Address - Fax:808-930-4721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-07
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care