Provider Demographics
NPI:1801657572
Name:ATHENA MEDICAL & WELLNESS LLC
Entity type:Organization
Organization Name:ATHENA MEDICAL & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PEI
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-283-5662
Mailing Address - Street 1:3688 CHESTER ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-2418
Mailing Address - Country:US
Mailing Address - Phone:541-283-5662
Mailing Address - Fax:541-866-3688
Practice Address - Street 1:3688 CHESTER ST
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-2418
Practice Address - Country:US
Practice Address - Phone:541-283-5662
Practice Address - Fax:541-866-3688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty