Provider Demographics
NPI:1649787599
Name:DIABETES WELLNESS SOLUTIONS, LLC
Entity type:Organization
Organization Name:DIABETES WELLNESS SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:STORMIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:M ED
Authorized Official - Phone:720-642-0459
Mailing Address - Street 1:6210 S NEWBERN WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-6133
Mailing Address - Country:US
Mailing Address - Phone:720-642-0459
Mailing Address - Fax:
Practice Address - Street 1:23911 E ARAPAHOE RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-4120
Practice Address - Country:US
Practice Address - Phone:720-642-0459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-01
Last Update Date:2018-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO53459305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization