Provider Demographics
NPI:1891410650
Name:3E WELLNESS LLC
Entity Type:Organization
Organization Name:3E WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:LEILANI
Authorized Official - Last Name:BRESHEARS
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD, CDCES
Authorized Official - Phone:808-620-5553
Mailing Address - Street 1:1050 QUEEN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4130
Mailing Address - Country:US
Mailing Address - Phone:808-620-5553
Mailing Address - Fax:833-672-3405
Practice Address - Street 1:1050 QUEEN ST STE 100
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4130
Practice Address - Country:US
Practice Address - Phone:808-620-5553
Practice Address - Fax:833-672-3405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty