Provider Demographics
NPI:1962833426
Name:DULA SPRINGS WELLNESS CENTER PA
Entity Type:Organization
Organization Name:DULA SPRINGS WELLNESS CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DANSEREAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-484-9032
Mailing Address - Street 1:6 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-9100
Mailing Address - Country:US
Mailing Address - Phone:828-484-9032
Mailing Address - Fax:
Practice Address - Street 1:6 MORNINGSIDE DR
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-9100
Practice Address - Country:US
Practice Address - Phone:828-484-9032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-10
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201001898207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7116Medicaid
NCD030Medicare PIN
KYK132630Medicare PIN