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General NPI Number Information
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NPI Number | 1114552916
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Entity Type | Organization
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Legal Business Name | WONDERFULLY MADE WELLNESS SANCTUARY
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Dates
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Enumeration Date | 03/12/2020
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Last Update Date | 09/03/2020
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Provider Practice Location Address
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Address Line | 105 S. TENNESSEE STREET SUITE 102
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City | MCKINNEY
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State | TX
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Zip | 75069
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Country | US
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Telephone | 469-631-0023
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Fax | 469-631-0209
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Provider Business Mailing Address
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Address Line | 105 S. TENNESSEE STREET SUITE 102
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City | MCKINNEY
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State | TX
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Zip | 75069
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Country | US
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Telephone | 469-631-0023
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Fax | 469-631-0209
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Authorized Official
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Title or Position | OWNER, CEO
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Name | MRS. MICHELLE KATHERINE ROWTON
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Credential | NP
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Telephone | 469-631-0023
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LN0005X
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Taxonomy Name | Critical Care Neonatal Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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