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General NPI Number Information
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NPI Number | 1295525640
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Entity Type | Organization
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Legal Business Name | LASTING WELLNESS, LLC
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Dates
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Enumeration Date | 05/08/2025
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 1505 MOUNT VERNON RD
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City | CHARLESTON
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State | WV
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Zip | 25314-2533
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Country | US
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Telephone | 606-424-6115
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Fax |
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Provider Business Mailing Address
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Address Line | 1505 MOUNT VERNON RD
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City | CHARLESTON
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State | WV
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Zip | 25314-2533
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Country | US
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Telephone | 606-424-6115
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | SAMANTHA SHAWVER
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Credential | NP-C
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Telephone | 606-424-6115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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