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General NPI Number Information
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NPI Number | 1467186288
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Entity Type | Organization
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Legal Business Name | SELF WELLNESS & HEALTH, PLLC
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Dates
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Enumeration Date | 07/16/2022
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Last Update Date | 07/16/2022
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Provider Practice Location Address
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Address Line | 4134 MACARTHUR ST
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City | WINSTON SALEM
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State | NC
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Zip | 27107-6124
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Country | US
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Telephone | 336-399-7716
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Fax |
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Provider Business Mailing Address
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Address Line | 4134 MACARTHUR ST
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City | WINSTON SALEM
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State | NC
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Zip | 27107-6124
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER/ ORGANIZER
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Name | TRACY GAFFNEY
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Credential | FNP-BC
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Telephone | 336-399-7716
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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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