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General NPI Number Information
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NPI Number | 1295448686
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Entity Type | Organization
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Legal Business Name | WELLNESS BY THE SEA MED SPA LLC
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Dates
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Enumeration Date | 12/30/2022
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Last Update Date | 12/30/2022
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Provider Practice Location Address
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Address Line | 35998 ZION CHURCH RD UNIT 1
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City | FRANKFORD
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State | DE
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Zip | 19945-4501
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Country | US
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Telephone | 302-278-0093
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Fax |
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Provider Business Mailing Address
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Address Line | 35998 ZION CHURCH RD UNIT 1
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City | FRANKFORD
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State | DE
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Zip | 19945-4501
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Country | US
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Telephone | 302-278-0093
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Fax |
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Authorized Official
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Title or Position | SOLE MBR
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Name | KIMBERLY CROCKETT-BRASURE
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Credential | APRN-CNP
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Telephone | 302-278-0093
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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