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General NPI Number Information
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NPI Number | 1639462765
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Entity Type | Organization
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Legal Business Name | WISDOM & WELLNESS
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Dates
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Enumeration Date | 05/23/2011
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Last Update Date | 11/23/2011
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Provider Practice Location Address
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Address Line | 659 PARK MEADOW RD STE J
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City | WESTERVILLE
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State | OH
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Zip | 43081-2879
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Country | US
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Telephone | 614-899-6877
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Fax | 614-899-6820
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Provider Business Mailing Address
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Address Line | PO BOX 2207
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City | WESTERVILLE
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State | OH
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Zip | 43086-2207
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Country | US
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Telephone | 614-899-6877
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Fax | 614-899-6820
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LUANN B. LAVIN
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Credential | C.N.P.
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Telephone | 614-738-3686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | NP-11102
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License Number State | OH
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