Provider Demographics
NPI:1790109023
Name:WEICHERT WELLNESS, LLC
Entity Type:Organization
Organization Name:WEICHERT WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRONWEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEICHERT
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:503-368-4393
Mailing Address - Street 1:PO BOX 1387
Mailing Address - Street 2:
Mailing Address - City:MANZANITA
Mailing Address - State:OR
Mailing Address - Zip Code:97130-1387
Mailing Address - Country:US
Mailing Address - Phone:503-368-4393
Mailing Address - Fax:503-368-4395
Practice Address - Street 1:123 LANEDA AVENUE
Practice Address - Street 2:
Practice Address - City:MANZANITA
Practice Address - State:OR
Practice Address - Zip Code:97130
Practice Address - Country:US
Practice Address - Phone:503-369-4393
Practice Address - Fax:503-368-4395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care