Healthcare Provider Details

I. General information

NPI: 1356008742
Provider Name (Legal Business Name): ENHANCED WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2021
Last Update Date: 11/20/2021
Certification Date: 11/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12425 OLD MERIDIAN ST STE B3
CARMEL IN
46032-8725
US

IV. Provider business mailing address

12425 OLD MERIDIAN ST STE B3
CARMEL IN
46032-8725
US

V. Phone/Fax

Practice location:
  • Phone: 844-770-0404
  • Fax:
Mailing address:
  • Phone: 844-770-0404
  • Fax:

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: DEANNA KIRK
Title or Position: OWNER
Credential: FNP
Phone: 844-770-0404