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NPI Code Detail

MEDICARE: ABUNDANT LIVING TOTAL WELLNESS LLC

MEDICARE: ABUNDANT LIVING TOTAL WELLNESS LLC
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
1363LF0000XFamily Nurse Practitioner

General Provider Information

NPI Number : 1861351579
Entity Type Code : Organization
Provider Name (Legal Business Name) : ABUNDANT LIVING TOTAL WELLNESS LLC
Provider Business Mailing Address
First Line : 3 KENSINGTON MNR APT 3
Second Line :
City : MIDDLETOWN
State : NY
Zip : 10941-1800
Country : US
Telephone Number : 845-637-9982
Fax Number :
Provider Business Practice Location Address
First Line : 60 PROSPECT AVE
Second Line :
City : MIDDLETOWN
State : NY
Zip : 10940-4133
Country : US
Telephone Number : 845-637-9982
Fax Number :
Authorized Official
Title or Position : OWNER
Name : TIERRA C OLIVER
Credential :
Telephone Number : 845-637-9982
Provider Enumeration Date : 01/19/2026
Last Update Date : 01/19/2026

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