Provider Demographics
NPI:1801426077
Name:COMMUNITY HEALTH AND WELLNESS CENTER, PLLC
Entity type:Organization
Organization Name:COMMUNITY HEALTH AND WELLNESS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & BUSINESS OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DWAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:NEWTON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:919-697-5474
Mailing Address - Street 1:7321 WATER WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-6705
Mailing Address - Country:US
Mailing Address - Phone:919-697-5474
Mailing Address - Fax:
Practice Address - Street 1:7321 WATER WILLOW DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-6705
Practice Address - Country:US
Practice Address - Phone:919-697-5474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1679947816OtherNPI