Provider Demographics
NPI:1922696897
Name:WELLNESS INTERVENTIONAL NEEDS & EDUCATION LLC
Entity Type:Organization
Organization Name:WELLNESS INTERVENTIONAL NEEDS & EDUCATION LLC
Other - Org Name:WELLNESS INTERVENTIONAL NEEDS & EDUCATION LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CASANDRA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, FNP-C
Authorized Official - Phone:618-401-9304
Mailing Address - Street 1:16 PEBBLE HILL DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-2250
Mailing Address - Country:US
Mailing Address - Phone:618-401-9304
Mailing Address - Fax:
Practice Address - Street 1:16 PEBBLE HILL DR
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-2250
Practice Address - Country:US
Practice Address - Phone:618-401-9304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-06
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty