Basic Information
| Provider Information | |||||||||
| NPI: | 1629548359 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ABUNDANT WELLNESS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 W WASHINGTON ST STE C1 | ||||||||
| Address2: | |||||||||
| City: | RIDGELAND | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391572434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018562383 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 W WASHINGTON ST STE C1 | ||||||||
| Address2: | |||||||||
| City: | RIDGELAND | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391572434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018562383 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/26/2018 | ||||||||
| LastUpdateDate: | 02/27/2020 | ||||||||
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| AuthorizedOfficialLastName: | GERMANY | ||||||||
| AuthorizedOfficialFirstName: | DANA | ||||||||
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| AuthorizedOfficialTitleorPosition: | FNP | ||||||||
| AuthorizedOfficialTelephone: | 6015274659 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.