=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184373359
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE CENTER FOR TRANSFORMATION HEALTH AND WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2022
-----------------------------------------------------
Last Update Date | 03/23/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 584 ROUTE 17
-----------------------------------------------------
City | RIDGEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07450-2000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-556-8210
-----------------------------------------------------
Fax | 201-857-3015
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 584 ROUTE 17
-----------------------------------------------------
City | RIDGEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07450-2000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-556-8210
-----------------------------------------------------
Fax | 201-857-3015
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER
-----------------------------------------------------
Name | EDWLANIA ALANE NOUH
-----------------------------------------------------
Credential | NP-C
-----------------------------------------------------
Telephone | 973-572-6085
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------