Healthcare Provider Details

I. General information

NPI: 1881132660
Provider Name (Legal Business Name): DE MORGAN WELLNESS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2017
Last Update Date: 03/17/2024
Certification Date: 03/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7271 N MAIN ST STE 2
DAYTON OH
45415-2561
US

IV. Provider business mailing address

7271 N MAIN ST STE 2
DAYTON OH
45415-2561
US

V. Phone/Fax

Practice location:
  • Phone: 937-609-0566
  • Fax: 937-991-0089
Mailing address:
  • Phone: 937-991-0082
  • Fax: 937-771-0836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberCOA07003NP
License Number StateOH

VIII. Authorized Official

Name: MS. SANDY MARIE ANDERSON
Title or Position: OWNER
Credential: FNP
Phone: 937-247-6360