Provider Demographics
NPI:1356728877
Name:WHOLEHEALTH MEDICAL AND WELLNESS
Entity type:Organization
Organization Name:WHOLEHEALTH MEDICAL AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:SHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-607-5270
Mailing Address - Street 1:524 W 300 N
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-2667
Mailing Address - Country:US
Mailing Address - Phone:801-607-5270
Mailing Address - Fax:801-607-5271
Practice Address - Street 1:524 W 300 N
Practice Address - Street 2:SUITE 203
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-2667
Practice Address - Country:US
Practice Address - Phone:801-607-5270
Practice Address - Fax:801-607-5271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty