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General NPI Number Information
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NPI Number | 1376226464
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Entity Type | Organization
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Legal Business Name | DOVE HYDRATION & WELLNESS, LLC
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Dates
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Enumeration Date | 08/08/2023
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Last Update Date | 08/08/2023
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Provider Practice Location Address
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Address Line | 950 N 35TH ST FL 2
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City | MILWAUKEE
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State | WI
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Zip | 53208-3318
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Country | US
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Telephone | 414-775-7739
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Fax |
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Provider Business Mailing Address
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Address Line | 950 N 35TH ST FL 2
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City | MILWAUKEE
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State | WI
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Zip | 53208-3318
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Country | US
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Telephone | 414-775-7739
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Fax |
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Authorized Official
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Title or Position | DIRECTOR / OWNER
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Name | LILLIAN MORENIKE ODUWOLE
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Credential |
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Telephone | 414-775-7739
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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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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