Healthcare Provider Details

I. General information

NPI: 1194484600
Provider Name (Legal Business Name): WELLNESS FAMILY MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2021
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 CYPRESS AVE STE 300
REDDING CA
96001-2743
US

IV. Provider business mailing address

1674 EL CAPITAN DR
REDDING CA
96001-2974
US

V. Phone/Fax

Practice location:
  • Phone: 530-768-9490
  • Fax: 530-653-2150
Mailing address:
  • Phone: 530-768-9490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GRETCHEN MELBURG
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 530-768-9490