Healthcare Provider Details

I. General information

NPI: 1104637586
Provider Name (Legal Business Name): PRECISION WELLNESS NP IN ADULT HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 NEW ST APT 1D
HEWLETT NY
11557-2021
US

IV. Provider business mailing address

16 NEW ST APT 1D
HEWLETT NY
11557-2021
US

V. Phone/Fax

Practice location:
  • Phone: 646-322-3742
  • Fax:
Mailing address:
  • Phone: 646-322-3742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RENAE T PACHECO
Title or Position: OWNER
Credential:
Phone: 646-322-3742