Provider Demographics
NPI:1134837198
Name:WNC HEALING COLLABORATIVE, PLLC
Entity type:Organization
Organization Name:WNC HEALING COLLABORATIVE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CONNER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:828-201-2758
Mailing Address - Street 1:32 N MAIN ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:NC
Mailing Address - Zip Code:28753-0317
Mailing Address - Country:US
Mailing Address - Phone:828-201-2758
Mailing Address - Fax:
Practice Address - Street 1:32 N MAIN ST UNIT 1
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:NC
Practice Address - Zip Code:28753-0317
Practice Address - Country:US
Practice Address - Phone:828-201-2758
Practice Address - Fax:877-371-6918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-09
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1902190416Medicaid