=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750184107
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WELLARIS HEALTH PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2025
-----------------------------------------------------
Last Update Date | 03/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 352 W VERDE LN
-----------------------------------------------------
City | TEMPE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85284-1345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-224-4101
-----------------------------------------------------
Fax | 480-908-1567
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 352 W VERDE LN
-----------------------------------------------------
City | TEMPE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85284-1345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-224-4101
-----------------------------------------------------
Fax | 480-908-1567
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PSYCHIATRIC NURSE PRACTITIONE
-----------------------------------------------------
Name | DR. PAULA DANIELLE BRUNGARDT
-----------------------------------------------------
Credential | DNP, APRN
-----------------------------------------------------
Telephone | 308-224-4101
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------