Provider Demographics
NPI:1013624394
Name:THE MAN CAVE TESTOSTERONE AND WELLNESS, PLLC
Entity Type:Organization
Organization Name:THE MAN CAVE TESTOSTERONE AND WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:910-801-0600
Mailing Address - Street 1:PO BOX 512
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:NC
Mailing Address - Zip Code:28332-0512
Mailing Address - Country:US
Mailing Address - Phone:910-991-5703
Mailing Address - Fax:
Practice Address - Street 1:2816 W BROAD ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NC
Practice Address - Zip Code:28337-9245
Practice Address - Country:US
Practice Address - Phone:910-801-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care