Provider Demographics
NPI:1790432730
Name:ELLA ESTA WELLNESS LLC
Entity Type:Organization
Organization Name:ELLA ESTA WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD PHLEBOTOMIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHATWAINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-452-5474
Mailing Address - Street 1:1601 5TH AVE N STE 147
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35203-1923
Mailing Address - Country:US
Mailing Address - Phone:205-427-7865
Mailing Address - Fax:
Practice Address - Street 1:1601 5TH AVE N STE 147
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35203-1923
Practice Address - Country:US
Practice Address - Phone:205-427-7865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory