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General NPI Number Information
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NPI Number | 1831476613
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Entity Type | Organization
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Legal Business Name | THE WELL FOR HEALTH, PLLC
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Dates
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Enumeration Date | 11/08/2011
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Last Update Date | 12/18/2019
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Provider Practice Location Address
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Address Line | 575 DAVIDSON GATEWAY DR STE 100
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City | DAVIDSON
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State | NC
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Zip | 28036
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Country | US
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Telephone | 704-799-5433
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Fax | 704-706-2446
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Provider Business Mailing Address
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Address Line | 575 DAVIDSON GATEWAY DR STE 100
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City | DAVIDSON
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State | NC
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Zip | 28036-7036
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Country | US
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Telephone | 704-799-5433
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Fax | 704-706-2446
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | DIANE MUDGE PARKS
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Credential | NP
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Telephone | 704-577-4630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 940100
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License Number State | NC
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