Provider Demographics
NPI:1831476613
Name:THE WELL FOR HEALTH, PLLC
Entity Type:Organization
Organization Name:THE WELL FOR HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:MUDGE
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:704-577-4630
Mailing Address - Street 1:575 DAVIDSON GATEWAY DR STE 100
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-7036
Mailing Address - Country:US
Mailing Address - Phone:704-799-5433
Mailing Address - Fax:704-706-2446
Practice Address - Street 1:575 DAVIDSON GATEWAY DR STE 100
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036
Practice Address - Country:US
Practice Address - Phone:704-799-5433
Practice Address - Fax:704-706-2446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-08
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC940100363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty