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General NPI Number Information
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NPI Number | 1740618693
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Entity Type | Organization
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Legal Business Name | MY WELLNESS 4 U
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Dates
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Enumeration Date | 10/30/2013
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Last Update Date | 10/30/2013
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Provider Practice Location Address
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Address Line | 39204 TACOMA DR
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City | LADY LAKE
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State | FL
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Zip | 32159-6006
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Country | US
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Telephone | 352-504-7456
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Fax |
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Provider Business Mailing Address
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Address Line | 39204 TACOMA DR
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City | LADY LAKE
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State | FL
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Zip | 32159-6006
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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 | OWNERQ
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Name | MISS MARGARET YEARWOOD
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Credential | P.A.
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Telephone | 352-504-7456
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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 | PA9104428
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License Number State | FL
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