Healthcare Provider Details

I. General information

NPI: 1508550583
Provider Name (Legal Business Name): WELLNESS CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11041 HENSELL RD
HOLLY MI
48442-8054
US

IV. Provider business mailing address

11041 HENSELL RD
HOLLY MI
48442-8054
US

V. Phone/Fax

Practice location:
  • Phone: 810-656-2208
  • Fax: 810-545-4196
Mailing address:
  • Phone: 810-656-2208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANGELA MARIE HANNA
Title or Position: NP/OWNER
Credential: AGACNP
Phone: 810-656-2208