Healthcare Provider Details

I. General information

NPI: 1417653031
Provider Name (Legal Business Name): ASTRA HEALTH AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 02/21/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

352 E RIVERSIDE DR STE A-1A
ST GEORGE UT
84790-6758
US

IV. Provider business mailing address

352 E RIVERSIDE DR STE A-1A
ST GEORGE UT
84790-6758
US

V. Phone/Fax

Practice location:
  • Phone: 801-809-2382
  • Fax:
Mailing address:
  • Phone: 435-565-1384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARANDA CARLILE
Title or Position: OWNER
Credential: NP
Phone: 435-565-1384