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General NPI Number Information
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NPI Number | 1972268886
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Entity Type | Organization
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Legal Business Name | DENALI HEALTH & WELLNESS
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Dates
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Enumeration Date | 11/04/2021
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Last Update Date | 11/04/2021
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Provider Practice Location Address
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Address Line | 185 SW BEDFORD RD
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953-6937
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Country | US
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Telephone | 772-607-0127
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Fax |
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Provider Business Mailing Address
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Address Line | 10380 SW VILLAGE CENTER DR STE 223
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34987-1931
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Country | US
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Telephone | 772-607-0127
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Fax |
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Authorized Official
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Title or Position | OWNER/APRN
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Name | MRS. MACRESIA A BRAZIEL
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Credential | APRN
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Telephone | 772-607-0127
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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 |
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License Number State |
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