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General NPI Number Information
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NPI Number | 1588255467
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Entity Type | Organization
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Legal Business Name | ESSENTIALYZE HEALTHCARE, LLC
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Dates
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Enumeration Date | 02/02/2021
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Last Update Date | 02/02/2021
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Provider Practice Location Address
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Address Line | 180 BROOME ST APT 1303
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City | NEW YORK
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State | NY
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Zip | 10002-1000
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Country | US
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Telephone | 305-927-6391
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Fax |
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Provider Business Mailing Address
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Address Line | 2207 HEDGEROW WAY
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City | JONESBORO
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State | GA
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Zip | 30236-9002
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Country | US
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Telephone | 305-927-6391
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHANDELLE WRONG
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Credential | NURSE PRACTITIONER
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Telephone | 305-927-6391
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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