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General NPI Number Information
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NPI Number | 1881333094
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Entity Type | Organization
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Legal Business Name | INTERSTELLAR HEALTH LLC
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Dates
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Enumeration Date | 06/04/2022
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Last Update Date | 07/20/2022
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Provider Practice Location Address
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Address Line | 980 N FEDERAL HWY STE 110
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City | BOCA RATON
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State | FL
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Zip | 33432-2704
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Country | US
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Telephone | 561-247-1734
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Fax |
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Provider Business Mailing Address
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Address Line | 9374 AEGEAN DR
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City | BOCA RATON
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State | FL
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Zip | 33496-6681
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Country | US
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Telephone | 561-206-2707
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WILLINE LOUIS
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Credential | APRN
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Telephone | 954-604-2227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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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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