Provider Demographics
NPI:1295353647
Name:WESTERN WELLNESS CLINIC LLC
Entity type:Organization
Organization Name:WESTERN WELLNESS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERRIER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:720-306-1247
Mailing Address - Street 1:1801 CHESTNUT PLACE UNIT 128
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202
Mailing Address - Country:US
Mailing Address - Phone:919-260-3852
Mailing Address - Fax:303-253-9643
Practice Address - Street 1:1801 CHESTNUT PLACE UNIT 128
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202
Practice Address - Country:US
Practice Address - Phone:919-260-3852
Practice Address - Fax:303-253-9643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service