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General NPI Number Information
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NPI Number | 1366791311
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Entity Type | Organization
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Legal Business Name | WELLNESS CENTER
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Dates
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Enumeration Date | 09/06/2012
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Last Update Date | 09/06/2012
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Provider Practice Location Address
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Address Line | 3525 FM 1960 RD EAST
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City | HUMBLE
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State | TX
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Zip | 77338
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Country | US
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Telephone | 281-540-1018
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Fax | 281-540-7581
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Provider Business Mailing Address
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Address Line | 3525 FM 1960 RD EAST
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City | HUMBLE
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State | TX
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Zip | 77338
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Country | US
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Telephone | 281-540-1018
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Fax | 281-540-7581
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Authorized Official
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Title or Position | OWNER
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Name | MARVIN WATSON
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Credential | NP
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Telephone | 281-540-1018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SF0001X
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Taxonomy Name | Family Health Clinical Nurse Specialist
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License Number | 777525
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License Number State | TX
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