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General NPI Number Information
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NPI Number | 1194482778
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Entity Type | Organization
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Legal Business Name | VAN HEALTH AND WELLNESS, PLLC
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Dates
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Enumeration Date | 11/18/2021
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Last Update Date | 11/18/2021
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Provider Practice Location Address
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Address Line | 488 W. MAIN STREET
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City | VAN
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State | TX
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Zip | 75790
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Country | US
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Telephone | 903-963-6850
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Fax |
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Provider Business Mailing Address
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Address Line | 2299 VZ COUNTY ROAD 4909
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City | BEN WHEELER
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State | TX
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Zip | 75754-4220
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Country | US
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Telephone | 903-368-0414
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CONSTANCE BENTLEY
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Credential | ANP-C
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Telephone | 903-368-0414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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