Provider Demographics
NPI:1801552039
Name:WELLINGTON GROUP PRACTITIONER STAFFING SERVICES LLC
Entity type:Organization
Organization Name:WELLINGTON GROUP PRACTITIONER STAFFING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORA
Authorized Official - Middle Name:
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:313-415-7240
Mailing Address - Street 1:16250 NORTHLAND DR STE 200A
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-5227
Mailing Address - Country:US
Mailing Address - Phone:313-415-7240
Mailing Address - Fax:
Practice Address - Street 1:16250 NORTHLAND DR STE 200A
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5227
Practice Address - Country:US
Practice Address - Phone:313-415-7240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty