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General NPI Number Information
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NPI Number | 1477420073
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Entity Type | Organization
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Legal Business Name | INNOVATIVE WELLNESS
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Dates
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Enumeration Date | 10/20/2025
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 14225 UNIVERSITY AVE STE 225
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City | WAUKEE
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State | IA
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Zip | 50263-8248
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Country | US
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Telephone | 515-355-3200
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Fax | 515-598-7626
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Provider Business Mailing Address
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Address Line | 14225 UNIVERSITY AVE STE 225
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City | WAUKEE
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State | IA
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Zip | 50263-8248
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Country | US
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Telephone | 515-355-3200
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Fax | 515-598-7626
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | WENDY WHITE
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Credential |
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Telephone | 304-688-7027
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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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