Provider Demographics
NPI:1982333621
Name:TAILORMADE HEALTH & WELLNESS
Entity Type:Organization
Organization Name:TAILORMADE HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ALESIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:972-719-2946
Mailing Address - Street 1:511 E JOHN CARPENTER FWY
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-3911
Mailing Address - Country:US
Mailing Address - Phone:972-719-2946
Mailing Address - Fax:949-266-8104
Practice Address - Street 1:511 E JOHN CARPENTER FWY
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-3911
Practice Address - Country:US
Practice Address - Phone:972-719-2946
Practice Address - Fax:949-266-8104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty