Provider Demographics
NPI:1790433456
Name:BALANCED WELLNESS LLC
Entity Type:Organization
Organization Name:BALANCED WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:918-716-9717
Mailing Address - Street 1:4142 S HARVARD AVE STE D3
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2617
Mailing Address - Country:US
Mailing Address - Phone:918-716-9717
Mailing Address - Fax:
Practice Address - Street 1:4142 S HARVARD AVE STE D3
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2617
Practice Address - Country:US
Practice Address - Phone:918-716-9717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty