Provider Demographics
NPI:1659129161
Name:JOHN-ANGELLA-REGINA PRIMARY CARE AND WELLNESS
Entity type:Organization
Organization Name:JOHN-ANGELLA-REGINA PRIMARY CARE AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WESTLEY
Authorized Official - Last Name:MAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:313-310-6761
Mailing Address - Street 1:27645 ALBERT ST
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1012
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27645 ALBERT ST
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1012
Practice Address - Country:US
Practice Address - Phone:313-310-6761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty