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General NPI Number Information
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NPI Number | 1477390128
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Entity Type | Organization
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Legal Business Name | EMPOWER WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 07/10/2024
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Last Update Date | 07/10/2024
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Provider Practice Location Address
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Address Line | 12722 TONKEL RD
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City | FORT WAYNE
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State | IN
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Zip | 46845-8200
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Country | US
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Telephone | 260-602-3472
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Fax |
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Provider Business Mailing Address
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Address Line | 12722 TONKEL RD
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City | FORT WAYNE
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State | IN
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Zip | 46845-8200
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Country | US
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Telephone | 260-602-3472
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER/CO-OWNER
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Name | STACIE LYNN HOUSHOLDER
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Credential | FNP-C
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Telephone | 260-602-3472
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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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