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General NPI Number Information
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NPI Number | 1639695935
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Entity Type | Organization
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Legal Business Name | MW WELLNESS VIII, LLC
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Dates
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Enumeration Date | 08/17/2017
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Last Update Date | 06/26/2023
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Provider Practice Location Address
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Address Line | 155 HAZARD AVE STE 2
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City | ENFIELD
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State | CT
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Zip | 06082
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Country | US
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Telephone | 813-228-6763
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Fax |
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Provider Business Mailing Address
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Address Line | 155 HAZARD AVE STE 2
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City | ENFIELD
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State | CT
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Zip | 06082-4586
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Country | US
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Telephone | 813-228-6763
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JODI DESPOY
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Credential |
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Telephone | 813-228-6334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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