Provider Demographics
NPI:1770646614
Name:WHOLE LIFE HEALTH CARE, PA
Entity Type:Organization
Organization Name:WHOLE LIFE HEALTH CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:COOMBS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:603-431-6677
Mailing Address - Street 1:100 SHATTUCK WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEWINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03801-8004
Mailing Address - Country:US
Mailing Address - Phone:603-431-6677
Mailing Address - Fax:603-610-2232
Practice Address - Street 1:100 SHATTUCK WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWINGTON
Practice Address - State:NH
Practice Address - Zip Code:03801-8004
Practice Address - Country:US
Practice Address - Phone:603-431-6677
Practice Address - Fax:603-610-2232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4345OtherANTHEM
4345OtherANTHEM
4345OtherANTHEM