Provider Demographics
NPI:1972012367
Name:WELLNESS BY THE SEA LLC
Entity Type:Organization
Organization Name:WELLNESS BY THE SEA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRASURE
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:302-278-0093
Mailing Address - Street 1:31707 BRASURE RD
Mailing Address - Street 2:
Mailing Address - City:DAGSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19939-4172
Mailing Address - Country:US
Mailing Address - Phone:302-278-0093
Mailing Address - Fax:302-278-0096
Practice Address - Street 1:35998 ZION CHURCH RD UNIT 1
Practice Address - Street 2:
Practice Address - City:FRANKFORD
Practice Address - State:DE
Practice Address - Zip Code:19945-4501
Practice Address - Country:US
Practice Address - Phone:302-278-0093
Practice Address - Fax:302-278-0096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-28
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty