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General NPI Number Information
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NPI Number | 1710658307
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Entity Type | Organization
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Legal Business Name | 360 HEALTH AND WELLNESS LLC
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Dates
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Enumeration Date | 09/23/2021
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Last Update Date | 09/23/2021
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Provider Practice Location Address
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Address Line | 5570 RICHMOND RD BSMT SUITE
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City | TROY
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State | VA
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Zip | 22974-4421
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Country | US
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Telephone | 540-360-1077
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Fax | 434-484-1919
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Provider Business Mailing Address
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Address Line | 5570 RICHMOND RD BSMT SUITE
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City | TROY
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State | VA
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Zip | 22974-4421
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Country | US
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Telephone | 540-360-1077
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Fax | 434-484-1919
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Authorized Official
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Title or Position | FNP-C
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Name | MRS. SHANNON MILLER
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Credential | NP
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Telephone | 540-360-1077
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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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