Provider Demographics
NPI:1801521299
Name:NE WELLNESS
Entity type:Organization
Organization Name:NE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NOAH
Authorized Official - Middle Name:
Authorized Official - Last Name:FROHLICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-399-6322
Mailing Address - Street 1:1717 2ND ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1139
Mailing Address - Country:US
Mailing Address - Phone:612-399-6322
Mailing Address - Fax:
Practice Address - Street 1:1717 2ND ST NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1139
Practice Address - Country:US
Practice Address - Phone:612-399-6322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health