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General NPI Number Information
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NPI Number | 1669296224
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Entity Type | Organization
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Legal Business Name | HOLISTIC MIND AND WELLNESS, LLC
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Dates
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Enumeration Date | 11/11/2024
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 141 E COURT ST
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City | BOWLING GREEN
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State | OH
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Zip | 43402-2467
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Country | US
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Telephone | 419-575-7911
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Fax |
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Provider Business Mailing Address
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Address Line | 711 BARNSTABLE LN
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City | BOWLING GREEN
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State | OH
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Zip | 43402-8740
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHRIZED OFFICIAL
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Name | MATTHEW EIFRID
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Credential |
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Telephone | 419-575-7911
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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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