Healthcare Provider Details

I. General information

NPI: 1568183366
Provider Name (Legal Business Name): ULTIMATE HYDRATION AND WELLNESS SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 09/09/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5847 RIDGEWAY DR
GRAND PRAIRIE TX
75052-0448
US

IV. Provider business mailing address

5847 RIDGEWAY DR
GRAND PRAIRIE TX
75052-0448
US

V. Phone/Fax

Practice location:
  • Phone: 214-460-4669
  • Fax:
Mailing address:
  • Phone: 214-460-4669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: DR. JULIANA NKEA ATEM
Title or Position: PRESIDENT/OWNER
Credential: DNP
Phone: 214-460-4669