Basic Information
| Provider Information | |||||||||
| NPI: | 1962685081 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WELLNESS RESTORATIVES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2117 MYTHEWOOD DR SW | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358031421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568811057 | ||||||||
| FaxNumber: | 2568305751 | ||||||||
| Practice Location | |||||||||
| Address1: | 1230 SLAUGHTER RD | ||||||||
| Address2: | SUITE C | ||||||||
| City: | MADISON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 357585900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2567220555 | ||||||||
| FaxNumber: | 2568305135 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2007 | ||||||||
| LastUpdateDate: | 12/12/2007 | ||||||||
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| AuthorizedOfficialLastName: | BROOKS | ||||||||
| AuthorizedOfficialFirstName: | DEBORAH | ||||||||
| AuthorizedOfficialMiddleName: | ANNETTE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER / CRNP | ||||||||
| AuthorizedOfficialTelephone: | 2568811057 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | CRNP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.