Provider Demographics
NPI:1790368710
Name:ROOTED IN WELLNESS FAMILY CARE, LLC
Entity Type:Organization
Organization Name:ROOTED IN WELLNESS FAMILY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:BUENING
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:937-417-4712
Mailing Address - Street 1:121 OAK HILL DR
Mailing Address - Street 2:
Mailing Address - City:SAINT HENRY
Mailing Address - State:OH
Mailing Address - Zip Code:45883-9647
Mailing Address - Country:US
Mailing Address - Phone:937-417-4712
Mailing Address - Fax:
Practice Address - Street 1:591 SOUTH EASTERN AVE
Practice Address - Street 2:
Practice Address - City:ST. HENRY
Practice Address - State:OH
Practice Address - Zip Code:45883-4588
Practice Address - Country:US
Practice Address - Phone:937-417-4712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty