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General NPI Number Information
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NPI Number | 1043732951
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Entity Type | Organization
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Legal Business Name | INTEGRATED HEALTH AND BEAUTY MEDICAL CENTER, LLC
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Dates
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Enumeration Date | 07/12/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4230 CORAL PARK DR
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City | BRUNSWICK
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State | GA
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Zip | 31520-3016
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Country | US
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Telephone | 912-223-1429
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Fax | 912-342-7058
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Provider Business Mailing Address
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Address Line | 4230 CORAL PARK DR
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City | BRUNSWICK
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State | GA
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Zip | 31520-3016
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Country | US
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Telephone | 912-223-1429
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Fax | 912-342-7058
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER HELLER
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Credential | DC
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Telephone | 636-357-4234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN260355
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License Number State |
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