Provider Demographics
NPI:1396543112
Name:ALINE WELLNESS A NURSING PC
Entity type:Organization
Organization Name:ALINE WELLNESS A NURSING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALIX
Authorized Official - Middle Name:
Authorized Official - Last Name:BARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-904-3849
Mailing Address - Street 1:348 HAUSER BLVD APT 314
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-5589
Mailing Address - Country:US
Mailing Address - Phone:574-904-3849
Mailing Address - Fax:
Practice Address - Street 1:5850 W 3RD ST STE E1099
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-2881
Practice Address - Country:US
Practice Address - Phone:574-904-3849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty