Healthcare Provider Details

I. General information

NPI: 1053977041
Provider Name (Legal Business Name): ENM WELLNESS & MORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2019
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W BROADWAY STE 4
LOUISVILLE KY
40202-2236
US

IV. Provider business mailing address

4205 NANEEN DR
LOUISVILLE KY
40216-3973
US

V. Phone/Fax

Practice location:
  • Phone: 502-963-5803
  • Fax:
Mailing address:
  • Phone: 502-314-1247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ERICA MAHONE
Title or Position: OWNER
Credential: APRN
Phone: 502-314-1247