Provider Demographics
NPI:1922567874
Name:MODERNDAY WELLNESS PLLC
Entity Type:Organization
Organization Name:MODERNDAY WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:DR
Authorized Official - First Name:MARQUITA
Authorized Official - Middle Name:WALLACE
Authorized Official - Last Name:BOGGESS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:704-737-9643
Mailing Address - Street 1:5123 CHEVIOT RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-4526
Mailing Address - Country:US
Mailing Address - Phone:704-502-5372
Mailing Address - Fax:
Practice Address - Street 1:903 NORTHEAST DR STE 102
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-7437
Practice Address - Country:US
Practice Address - Phone:704-737-9643
Practice Address - Fax:980-231-0080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty