Provider Demographics
NPI:1891464905
Name:INCLUSA HEALTH AND WELLNESS PLLC
Entity Type:Organization
Organization Name:INCLUSA HEALTH AND WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PERSONDEK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:208-755-6731
Mailing Address - Street 1:21600 E MERIWETHER LN
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-7629
Mailing Address - Country:US
Mailing Address - Phone:208-755-6731
Mailing Address - Fax:
Practice Address - Street 1:23403 E MISSION AVE STE 215
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-7626
Practice Address - Country:US
Practice Address - Phone:509-367-4209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VB0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObesity MedicineGroup - Single Specialty