Healthcare Provider Details

I. General information

NPI: 1750685178
Provider Name (Legal Business Name): WELLNESS I NURSE PRACTITIONER IN FAMILY HEALTH, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2010
Last Update Date: 12/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 N MAIN ST SUITE 6
NEW CITY NY
10956-4310
US

IV. Provider business mailing address

337 N MAIN ST SUITE 6
NEW CITY NY
10956-4310
US

V. Phone/Fax

Practice location:
  • Phone: 845-638-4574
  • Fax: 845-638-9436
Mailing address:
  • Phone: 845-638-4574
  • Fax: 845-638-9436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number334278
License Number StateNY

VIII. Authorized Official

Name: PATRICIA HALO
Title or Position: PRESIDENT
Credential: F.N.P.
Phone: 845-638-4574