Provider Demographics
NPI:1801626569
Name:NEW WAVERLY WELLNESS CLINIC
Entity type:Organization
Organization Name:NEW WAVERLY WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:STEFANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KREJCI
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:832-766-6041
Mailing Address - Street 1:655 I-45 S. FEEDER RD
Mailing Address - Street 2:
Mailing Address - City:NEW WAVERLY
Mailing Address - State:TX
Mailing Address - Zip Code:77358-4225
Mailing Address - Country:US
Mailing Address - Phone:832-263-0834
Mailing Address - Fax:
Practice Address - Street 1:655 I-45 S FEEDER RD
Practice Address - Street 2:
Practice Address - City:NEW WAVERLY
Practice Address - State:TX
Practice Address - Zip Code:77358-4225
Practice Address - Country:US
Practice Address - Phone:832-263-0834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ESSENTIAL IV THERAPY & AESTHETICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center