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General NPI Number Information
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NPI Number | 1407437692
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Entity Type | Organization
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Legal Business Name | AT PEACE WELLNESS LLC
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Dates
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Enumeration Date | 04/19/2021
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 1001 EASTON RD STE 104
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City | WILLOW GROVE
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State | PA
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Zip | 19090-2037
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Country | US
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Telephone | 267-403-1475
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Fax | 877-866-2051
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Provider Business Mailing Address
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Address Line | PO BOX 29718
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City | ELKINS PARK
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State | PA
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Zip | 19027-0918
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Country | US
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Telephone | 267-403-1475
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EBONY CHATMON
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Credential | NURSE PRACTITIONER
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Telephone | 267-264-8926
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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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