Healthcare Provider Details

I. General information

NPI: 1609491976
Provider Name (Legal Business Name): NSPYRED WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2020
Last Update Date: 06/12/2020
Certification Date: 06/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9505 WARWICK BLVD
NEWPORT NEWS VA
23601-4538
US

IV. Provider business mailing address

9505 WARWICK BLVD
NEWPORT NEWS VA
23601-4538
US

V. Phone/Fax

Practice location:
  • Phone: 415-849-0591
  • Fax:
Mailing address:
  • Phone: 415-849-0591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name: NIKKI J JEWELL
Title or Position: OWNER
Credential:
Phone: 202-607-6738