MEDICARE: WELLNEST CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1528743184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNEST CORPORATION

Provider Business Mailing Address
First Line	:	720 W LAKE ST STE 105
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2963
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	720 W LAKE ST STE 105
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2963
Country	:	US
Telephone Number	:	612-388-9124
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AMIR MOHAMED
Credential	:
Telephone Number	:	612-388-9124

Provider Enumeration Date	:	06/20/2023
Last Update Date	:	06/20/2023

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Directions to “WELLNEST CORPORATION ” Practice Location

Language	Start Address	Practice Location

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