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General NPI Number Information
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NPI Number | 1457135030
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Entity Type | Organization
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Legal Business Name | WELLNESS WITHIN, LLC
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Dates
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Enumeration Date | 08/23/2023
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Last Update Date | 08/23/2023
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Provider Practice Location Address
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Address Line | 215 MAIN ST. #211
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City | KETCHIKAN
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State | AK
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Zip | 99901
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Country | US
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Telephone | 72-541-6909
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5284
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City | KETCHIKAN
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State | AK
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Zip | 99901-0284
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Country | US
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Telephone | 907-254-1690
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Fax |
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Authorized Official
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Title or Position | OWNER/PROGRAM ADMINISTRATOR
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Name | SHARYL YEISLEY
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Credential |
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Telephone | 72-541-6909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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