Provider Demographics
NPI:1265915078
Name:RENEWED WELLNESS LLC
Entity type:Organization
Organization Name:RENEWED WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:575-736-6222
Mailing Address - Street 1:201 W RICHARDSON AVE
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210-2458
Mailing Address - Country:US
Mailing Address - Phone:575-736-6222
Mailing Address - Fax:575-736-6311
Practice Address - Street 1:201 W RICHARDSON AVE
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-2458
Practice Address - Country:US
Practice Address - Phone:575-736-6222
Practice Address - Fax:575-736-6311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-08
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty