Provider Demographics
NPI:1801190566
Name:MARION WELLNESS AND DISEASE MANAGEMENT PLLC
Entity Type:Organization
Organization Name:MARION WELLNESS AND DISEASE MANAGEMENT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTITIONER/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCNUTT
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:828-652-8196
Mailing Address - Street 1:59 GYPSY MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-9715
Mailing Address - Country:US
Mailing Address - Phone:828-652-8196
Mailing Address - Fax:828-652-8186
Practice Address - Street 1:59 GYPSY MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-9715
Practice Address - Country:US
Practice Address - Phone:828-652-8196
Practice Address - Fax:828-652-8186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC900271261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care