Provider Demographics
NPI:1851913263
Name:BODY WISDOM WELLNESS
Entity Type:Organization
Organization Name:BODY WISDOM WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LADONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:NATUROPATHIC PRACTIT
Authorized Official - Phone:302-377-4088
Mailing Address - Street 1:1000 SMYRNA CLAYTON BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-2228
Mailing Address - Country:US
Mailing Address - Phone:302-508-5511
Mailing Address - Fax:
Practice Address - Street 1:1000 SMYRNA CLAYTON BLVD STE 3
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-2228
Practice Address - Country:US
Practice Address - Phone:302-508-5511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Single Specialty