Provider Demographics
NPI:1831933548
Name:PLATINUM HEALTH AND WELLNESS LLC
Entity type:Organization
Organization Name:PLATINUM HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:STICKNEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:APRN
Authorized Official - Phone:330-421-2291
Mailing Address - Street 1:22610 LORAIN RD STE UR
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-2214
Mailing Address - Country:US
Mailing Address - Phone:330-421-2291
Mailing Address - Fax:
Practice Address - Street 1:22610 LORAIN RD STE UR
Practice Address - Street 2:
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-2214
Practice Address - Country:US
Practice Address - Phone:330-421-2291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-19
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty