Provider Demographics
NPI:1265276505
Name:ARIZON WELLNESS LLC
Entity type:Organization
Organization Name:ARIZON WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:NDEMATEBEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-655-4524
Mailing Address - Street 1:735 DUGAN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-7124
Mailing Address - Country:US
Mailing Address - Phone:614-655-4524
Mailing Address - Fax:
Practice Address - Street 1:735 DUGAN RIDGE DR
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-7124
Practice Address - Country:US
Practice Address - Phone:614-655-4524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty