Provider Demographics
NPI:1952072886
Name:VIRTUAL WELLNESS CLINIC LLC
Entity Type:Organization
Organization Name:VIRTUAL WELLNESS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTABEL
Authorized Official - Middle Name:SARFO
Authorized Official - Last Name:ADOMAKO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:513-291-2099
Mailing Address - Street 1:4483 WELL SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-6274
Mailing Address - Country:US
Mailing Address - Phone:513-291-2099
Mailing Address - Fax:
Practice Address - Street 1:1846 E INNOVATION PARK DR STE 1
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-1963
Practice Address - Country:US
Practice Address - Phone:513-291-2099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty