Provider Demographics
NPI:1497544704
Name:GRACEFUL WELLNESS & ESSENTIAL NURSING LLC
Entity type:Organization
Organization Name:GRACEFUL WELLNESS & ESSENTIAL NURSING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANESTRA
Authorized Official - Middle Name:LATSHA
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:216-288-9229
Mailing Address - Street 1:2544 W SUNLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-4503
Mailing Address - Country:US
Mailing Address - Phone:216-288-9229
Mailing Address - Fax:
Practice Address - Street 1:2544 W SUNLAND AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-4503
Practice Address - Country:US
Practice Address - Phone:216-288-9229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty