Healthcare Provider Details

I. General information

NPI: 1619471067
Provider Name (Legal Business Name): WELLNESS SUITE 360,P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 03/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 EARLIN AVE STE 290
BROWNS MILLS NJ
08015-1745
US

IV. Provider business mailing address

10 EARLIN AVE STE 290
BROWNS MILLS NJ
08015-1745
US

V. Phone/Fax

Practice location:
  • Phone: 908-337-8041
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: RHODA DONAT-FLOWERS
Title or Position: OWNER
Credential: D.O
Phone: 908-337-8041