Healthcare Provider Details

I. General information

NPI: 1073335956
Provider Name (Legal Business Name): EMPOWEING MINDS BODY @WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 N CENTRAL AVE STE 803
PHOENIX AZ
85004-1021
US

IV. Provider business mailing address

2828 N CENTRAL AVE STE 803
PHOENIX AZ
85004-1021
US

V. Phone/Fax

Practice location:
  • Phone: 404-610-1236
  • Fax: 855-300-5330
Mailing address:
  • Phone: 404-610-1236
  • Fax: 855-300-5330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: VARONICA FREEMAN
Title or Position: MANAGER
Credential:
Phone: 513-260-9643