Provider Demographics
NPI:1790563252
Name:ALIVE HEALTH & WELLNESS
Entity Type:Organization
Organization Name:ALIVE HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JENEA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT-TALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, DNP, FNP-C
Authorized Official - Phone:804-636-3918
Mailing Address - Street 1:6804 WOODLAKE COMMONS LOOP
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2281
Mailing Address - Country:US
Mailing Address - Phone:804-636-3918
Mailing Address - Fax:804-331-6173
Practice Address - Street 1:6804 WOODLAKE COMMONS LOOP
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2281
Practice Address - Country:US
Practice Address - Phone:804-636-3918
Practice Address - Fax:804-331-6173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty