Provider Demographics
NPI:1801609292
Name:INTERTWINED WELLNESS CARE
Entity type:Organization
Organization Name:INTERTWINED WELLNESS CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP
Authorized Official - Prefix:
Authorized Official - First Name:SHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:360-259-8300
Mailing Address - Street 1:4305 9TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-4062
Mailing Address - Country:US
Mailing Address - Phone:360-259-8300
Mailing Address - Fax:
Practice Address - Street 1:3624 ENSIGN RD NE STE F
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5114
Practice Address - Country:US
Practice Address - Phone:360-226-8153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily