Provider Demographics
NPI:1861649923
Name:MARY F WELLHONER LTD A NEVADA
Entity Type:Organization
Organization Name:MARY F WELLHONER LTD A NEVADA
Other - Org Name:WOMEN'S WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:F
Authorized Official - Last Name:WELLHONER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-352-9355
Mailing Address - Street 1:645 SIERRA ROSE DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2366
Mailing Address - Country:US
Mailing Address - Phone:775-352-9355
Mailing Address - Fax:775-352-3575
Practice Address - Street 1:645 SIERRA ROSE DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2366
Practice Address - Country:US
Practice Address - Phone:775-352-9355
Practice Address - Fax:775-352-3575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8741207VG0400X
261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1467561597OtherINDIVIDUAL NPI
NV002016598Medicaid
NVV31438Medicare PIN
NVF33988Medicare UPIN