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General NPI Number Information
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NPI Number | 1639734213
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Entity Type | Organization
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Legal Business Name | IDEAL WELLNESS FAMILY PRACTICE, PC
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Dates
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Enumeration Date | 05/08/2019
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Last Update Date | 08/05/2019
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Provider Practice Location Address
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Address Line | 701 LEON AVE
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City | PALMYRA
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State | PA
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Zip | 17078-3554
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Country | US
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Telephone | 717-256-1820
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Fax |
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Provider Business Mailing Address
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Address Line | 511 BYLER CIR
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City | LEBANON
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State | PA
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Zip | 17042-4866
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Country | US
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Telephone | 609-731-3478
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JESSICA AMANDA ORNER
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Credential | MD
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Telephone | 609-731-3478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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