Basic Information
| Provider Information | |||||||||
| NPI: | 1922659416 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WELLNESS FOR LIFE PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 648 ALMONDRIDGE DR | ||||||||
| Address2: | |||||||||
| City: | RURAL HALL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 270459887 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3369691185 | ||||||||
| FaxNumber: | 3369691186 | ||||||||
| Practice Location | |||||||||
| Address1: | 648 ALMONDRIDGE DR | ||||||||
| Address2: | |||||||||
| City: | RURAL HALL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 270459887 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3369691185 | ||||||||
| FaxNumber: | 3369691186 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2019 | ||||||||
| LastUpdateDate: | 09/25/2019 | ||||||||
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| AuthorizedOfficialLastName: | CORDIAL | ||||||||
| AuthorizedOfficialFirstName: | LORI | ||||||||
| AuthorizedOfficialMiddleName: | OAKLEY | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3364072754 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.