Healthcare Provider Details

I. General information

NPI: 1649141987
Provider Name (Legal Business Name): EMPOWER WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1665 HARTFORD AVE STE 4
JOHNSTON RI
02919-3268
US

IV. Provider business mailing address

1665 HARTFORD AVE UNIT BOX 4
JOHNSTON RI
02919-3200
US

V. Phone/Fax

Practice location:
  • Phone: 401-237-0131
  • Fax:
Mailing address:
  • Phone: 401-237-0131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: MS. NICOLE JILL WHALEN
Title or Position: OWNER
Credential:
Phone: 401-300-7542