Healthcare Provider Details

I. General information

NPI: 1023469178
Provider Name (Legal Business Name): NORTH AUSTIN ALLERGY AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 MEDICAL PKWY UNIT 440
AUSTIN TX
78705-1019
US

IV. Provider business mailing address

3705 MEDICAL PKWY UNIT 440
AUSTIN TX
78705-1019
US

V. Phone/Fax

Practice location:
  • Phone: 512-215-8985
  • Fax: 512-215-8517
Mailing address:
  • Phone: 512-215-8985
  • Fax: 512-215-8517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN NELSON
Title or Position: OWNER
Credential:
Phone: 512-215-8985