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General NPI Number Information
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NPI Number | 1255087722
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Entity Type | Organization
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Legal Business Name | WELLSTEAD HEALTH
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Dates
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Enumeration Date | 02/23/2022
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Last Update Date | 02/28/2022
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Provider Practice Location Address
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Address Line | 75 MARKET ST STE 103
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City | PORTLAND
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State | ME
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Zip | 04101-5040
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Country | US
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Telephone | 978-831-2438
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Fax |
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Provider Business Mailing Address
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Address Line | 75 MARKET ST STE 103
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City | PORTLAND
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State | ME
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Zip | 04101-5040
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Country | US
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Telephone | 978-831-2438
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Fax |
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Authorized Official
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Title or Position | CO-FOUNDER
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Name | BONNY ROLLENDER
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Credential |
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Telephone | 978-831-2438
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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