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General NPI Number Information
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NPI Number | 1578330304
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Entity Type | Organization
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Legal Business Name | THRIVE LIFE WELLNESS PLLC
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Dates
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Enumeration Date | 12/12/2023
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 826 S 2ND AVE STE B
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City | WALLA WALLA
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State | WA
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Zip | 99362-4059
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Country | US
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Telephone | 95-401-7595
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Fax | 833-450-5993
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Provider Business Mailing Address
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Address Line | 826 S 2ND AVE STE B
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City | WALLA WALLA
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State | WA
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Zip | 99362-4059
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Country | US
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Telephone | 509-540-1759
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Fax | 833-450-5993
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Authorized Official
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Title or Position | OWNER/FAMILY NURSE PRACTITIONER
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Name | CRISTAL BUESCHER
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Credential | FNP
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Telephone | 509-240-4718
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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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