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General NPI Number Information
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NPI Number | 1194484600
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Entity Type | Organization
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Legal Business Name | WELLNESS FAMILY MEDICINE, PC
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Dates
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Enumeration Date | 12/12/2021
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Last Update Date | 02/16/2023
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Provider Practice Location Address
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Address Line | 760 CYPRESS AVE STE 300
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City | REDDING
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State | CA
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Zip | 96001-2743
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Country | US
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Telephone | 530-768-9490
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Fax | 530-653-2150
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Provider Business Mailing Address
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Address Line | 1674 EL CAPITAN DR
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City | REDDING
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State | CA
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Zip | 96001-2974
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Country | US
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Telephone | 530-768-9490
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | GRETCHEN MELBURG
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Credential |
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Telephone | 530-768-9490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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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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