Provider Demographics
NPI:1770310765
Name:LAG HEART AND WELLNESS CONSULTING, LLC
Entity type:Organization
Organization Name:LAG HEART AND WELLNESS CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:WINESTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, FNP-BC
Authorized Official - Phone:803-549-2712
Mailing Address - Street 1:226 SEPIA CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7821
Mailing Address - Country:US
Mailing Address - Phone:803-549-2712
Mailing Address - Fax:
Practice Address - Street 1:4615 FOREST DR STE 2
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29206-3168
Practice Address - Country:US
Practice Address - Phone:803-563-8042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty