Healthcare Provider Details

I. General information

NPI: 1487174033
Provider Name (Legal Business Name): MW WELLNESS VII, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4930 FRUITVILLE RD
SARASOTA FL
34232-2206
US

IV. Provider business mailing address

4930 FRUITVILLE RD
SARASOTA FL
34232-2206
US

V. Phone/Fax

Practice location:
  • Phone: 941-954-3800
  • Fax:
Mailing address:
  • Phone: 941-954-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: WENDIE NONCLERC
Title or Position: DIRECTOR OF INSURANCE
Credential:
Phone: 813-228-6334