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General NPI Number Information
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NPI Number | 1508487604
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Entity Type | Organization
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Legal Business Name | EVOLVE WELLNESS
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Dates
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Enumeration Date | 04/29/2020
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Last Update Date | 04/29/2020
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Provider Practice Location Address
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Address Line | 3830 W RIVER RD STE 106
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City | TUCSON
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State | AZ
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Zip | 85741-3793
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Country | US
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Telephone | 520-638-6277
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Fax |
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Provider Business Mailing Address
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Address Line | 3830 W RIVER RD STE 106
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City | TUCSON
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State | AZ
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Zip | 85741-3793
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Country | US
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Telephone | 520-638-6277
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KATE O'REILLY
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Credential |
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Telephone | 520-345-7776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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