Healthcare Provider Details

I. General information

NPI: 1548096258
Provider Name (Legal Business Name): WILDFLOWER TELEHEALTH NETWORK INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1999 BRYAN ST STE 900
DALLAS TX
75201-3140
US

IV. Provider business mailing address

2443 FILLMORE ST # 380-6499
SAN FRANCISCO CA
94115-1814
US

V. Phone/Fax

Practice location:
  • Phone: 516-480-9100
  • Fax:
Mailing address:
  • Phone: 516-480-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name: NASH PRINCE
Title or Position: SVP GROWTH
Credential:
Phone: 516-480-9100