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General NPI Number Information
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NPI Number | 1154712271
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Entity Type | Organization
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Legal Business Name | WELLNESS NETWORKS, INC
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Dates
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Enumeration Date | 02/11/2015
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Last Update Date | 02/02/2026
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Provider Practice Location Address
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Address Line | 64 VICTOR ST
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City | HIGHLAND PARK
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State | MI
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Zip | 48203-3128
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Country | US
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Telephone | 313-446-9800
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Fax | 313-446-9839
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Provider Business Mailing Address
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Address Line | 64 VICTOR ST
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City | HIGHLAND PARK
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State | MI
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Zip | 48203-3128
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Country | US
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Telephone | 313-446-9800
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Fax | 313-446-9839
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Authorized Official
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Title or Position | PROVIDER ENROLLMENT MANGER
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Name | TANYA MAULDIN
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Credential |
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Telephone | 414-225-1611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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