Provider Demographics
NPI:1790561678
Name:INTEGRITY MEDICAL AND HEALING CARE GROUP
Entity Type:Organization
Organization Name:INTEGRITY MEDICAL AND HEALING CARE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KHALENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANSELMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-570-7775
Mailing Address - Street 1:1931 NW 150TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2877
Mailing Address - Country:US
Mailing Address - Phone:954-906-1872
Mailing Address - Fax:
Practice Address - Street 1:1931 NW 150TH AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2877
Practice Address - Country:US
Practice Address - Phone:954-906-1872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-06
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty