Healthcare Provider Details

I. General information

NPI: 1649958927
Provider Name (Legal Business Name): SALTWATER INTEGRATIVE WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2023
Last Update Date: 07/07/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28467 DUPONT BLVD UNIT 6
MILLSBORO DE
19966-3749
US

IV. Provider business mailing address

28467 DUPONT BLVD UNIT 6
MILLSBORO DE
19966-3749
US

V. Phone/Fax

Practice location:
  • Phone: 302-272-9738
  • Fax: 866-371-4672
Mailing address:
  • Phone: 302-272-9738
  • Fax: 866-371-4672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State

VIII. Authorized Official

Name: ANITA L BECKLIN-TYNDALL
Title or Position: OWNER/ADMIN
Credential: CRNP
Phone: 302-841-4728