Provider Demographics
NPI:1942325055
Name:WESTRA WELLNESS CENTER
Entity Type:Organization
Organization Name:WESTRA WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:FREEMAN
Authorized Official - Last Name:WESTRA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:704-732-3346
Mailing Address - Street 1:112 DOCTORS PARK
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-4406
Mailing Address - Country:US
Mailing Address - Phone:704-732-3346
Mailing Address - Fax:704-732-6863
Practice Address - Street 1:112 DOCTORS PARK
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-4406
Practice Address - Country:US
Practice Address - Phone:704-732-3346
Practice Address - Fax:704-732-6863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23891207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty