Provider Demographics
NPI:1720635840
Name:POWER OF WELLNESS HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:POWER OF WELLNESS HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HULSTINE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:866-243-7203
Mailing Address - Street 1:PO BOX 7691
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-2691
Mailing Address - Country:US
Mailing Address - Phone:866-243-7203
Mailing Address - Fax:833-243-7203
Practice Address - Street 1:3528 TONGASS AVE
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5635
Practice Address - Country:US
Practice Address - Phone:907-220-4447
Practice Address - Fax:907-247-8782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-22
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty