Provider Demographics
NPI:1255100558
Name:MOBILE TOTAL WELLNESS, PLLC
Entity type:Organization
Organization Name:MOBILE TOTAL WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOFTUS
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:206-853-2469
Mailing Address - Street 1:14205 SE 36TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1553
Mailing Address - Country:US
Mailing Address - Phone:206-853-2469
Mailing Address - Fax:
Practice Address - Street 1:18725 134TH ST E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-8761
Practice Address - Country:US
Practice Address - Phone:206-853-2469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty