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General NPI Number Information
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NPI Number | 1689326837
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Entity Type | Organization
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Legal Business Name | BEACON WELLNESS SOLUTIONS LLC
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Dates
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Enumeration Date | 01/19/2022
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Last Update Date | 10/24/2023
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Provider Practice Location Address
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Address Line | 101 LEWIS ST STE 2
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City | PETOSKEY
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State | MI
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Zip | 49770
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Country | US
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Telephone | 231-881-8838
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Fax | 231-622-8037
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Provider Business Mailing Address
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Address Line | 101 LEWIS ST STE 2
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City | PETOSKEY
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State | MI
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Zip | 49770
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Country | US
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Telephone | 231-881-8838
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Fax |
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Authorized Official
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Title or Position | PROVIDER/MEMBER
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Name | MRS. KAROLYN WILDER
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Credential | PMHNP-BC
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Telephone | 231-881-8838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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