Provider Demographics
NPI:1962685081
Name:WELLNESS RESTORATIVES, LLC
Entity Type:Organization
Organization Name:WELLNESS RESTORATIVES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CRNP
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:256-881-1057
Mailing Address - Street 1:2117 MYTHEWOOD DR SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35803-1421
Mailing Address - Country:US
Mailing Address - Phone:256-881-1057
Mailing Address - Fax:256-830-5751
Practice Address - Street 1:1230 SLAUGHTER RD
Practice Address - Street 2:SUITE C
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-5900
Practice Address - Country:US
Practice Address - Phone:256-722-0555
Practice Address - Fax:256-830-5135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty