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General NPI Number Information
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NPI Number | 1316544844
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Entity Type | Organization
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Legal Business Name | THE WELLNESS CONNECTION LLC
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Dates
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Enumeration Date | 10/07/2020
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Last Update Date | 11/25/2020
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Provider Practice Location Address
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Address Line | 83 N AMBER CT
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City | CHANDLER
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State | AZ
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Zip | 85225-5726
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Country | US
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Telephone | 602-679-4228
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Fax |
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Provider Business Mailing Address
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Address Line | 83 N AMBER CT
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City | CHANDLER
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State | AZ
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Zip | 85225-5726
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Country | US
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Telephone | 602-679-4228
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | MS. JANN M FORD PETERSEN
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Credential | FNP-C
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Telephone | 602-679-4228
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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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