=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528661782
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTH & WELLNESS 365 LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2020
-----------------------------------------------------
Last Update Date | 11/19/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2404 KINSELLA WAY
-----------------------------------------------------
City | ROSEVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95747-9574
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-929-6244
-----------------------------------------------------
Fax | 918-398-8932
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2404 KINSELLA WAY
-----------------------------------------------------
City | ROSEVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95747-9178
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-929-6244
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT & CEO
-----------------------------------------------------
Name | DR. MELISSA MEKELLA GEORGE
-----------------------------------------------------
Credential | DNP, FNP-BC, CDCES
-----------------------------------------------------
Telephone | 916-827-0463
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133NN1002X
-----------------------------------------------------
Taxonomy Name | Nutrition Education Nutritionist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------