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General NPI Number Information
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NPI Number | 1881974731
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Entity Type | Organization
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Legal Business Name | THE WELLNESS AND PREVENTION CENTER, LLC
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Dates
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Enumeration Date | 08/24/2011
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Last Update Date | 01/17/2020
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Provider Practice Location Address
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Address Line | 5700 W OLIVE AVE STE 102
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City | GLENDALE
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State | AZ
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Zip | 85302-3147
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Country | US
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Telephone | 623-387-3705
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Fax | 866-941-5662
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Provider Business Mailing Address
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Address Line | PO BOX 417
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City | PEORIA
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State | AZ
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Zip | 85380-0417
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Country | US
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Telephone | 623-387-3705
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Fax | 866-941-5662
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Authorized Official
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Title or Position | OWNER
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Name | KATRINA M SPRADLING
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Credential | FNP-C
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Telephone | 623-387-3705
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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 | AP3720
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License Number State | AZ
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