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General NPI Number Information
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NPI Number | 1154172773
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Entity Type | Organization
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Legal Business Name | WELLNESS360 PRIMARY CARE
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Dates
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Enumeration Date | 04/01/2024
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Last Update Date | 04/01/2024
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Provider Practice Location Address
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Address Line | 1700 SE HILLMOOR DR STE 305
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-7536
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Country | US
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Telephone | 772-292-8188
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 SE HILLMOOR DR STE 305
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-7536
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | YOHANNA DENO
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Credential | MD
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Telephone | 764-670-2685
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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