Provider Demographics
NPI:1821700014
Name:THRIVEWELL HEALTH LLC
Entity Type:Organization
Organization Name:THRIVEWELL HEALTH LLC
Other - Org Name:AZURA WELLNESS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER & CEO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MPH,PMHNP-BC, FNP-C
Authorized Official - Phone:301-985-2898
Mailing Address - Street 1:4701 SANGAMORE RD # 100N
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20816-2558
Mailing Address - Country:US
Mailing Address - Phone:301-985-2898
Mailing Address - Fax:301-985-2890
Practice Address - Street 1:4701 SANGAMORE RD # 100N
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20816-2558
Practice Address - Country:US
Practice Address - Phone:301-985-2898
Practice Address - Fax:301-985-2890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-19
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty