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NPI Code Detail

MEDICARE: WC WELLNESS LLC

MEDICARE: WC WELLNESS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse PractitionerARNP1348922FL
2363LP0808XPsychiatric/Mental Health Nurse PractitionerARNP2053552FL
3363LP0808XPsychiatric/Mental Health Nurse PractitionerARNP2876402FL
42084P0800XPsychiatry PhysicianME63070FL

General Provider Information

NPI Number : 1013147834
Entity Type Code : Organization
Provider Name (Legal Business Name) : WC WELLNESS LLC
Provider Business Mailing Address
First Line : 600 SW 3RD ST
Second Line : SUITE 2270
City : POMPANO BEACH
State : FL
Zip : 33060-6932
Country : US
Telephone Number : 954-241-0303
Fax Number :
Provider Business Practice Location Address
First Line : 600 SW 3RD ST
Second Line : SUITE 2270
City : POMPANO BEACH
State : FL
Zip : 33060-6932
Country : US
Telephone Number : 954-241-0303
Fax Number :
Authorized Official
Title or Position : TREASURER
Name : MR. PHIL DETOURNILLON
Credential :
Telephone Number : 954-241-0303
Provider Enumeration Date : 07/15/2009
Last Update Date : 07/15/2009

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Directions to “WC WELLNESS LLC ” Practice Location

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