MEDICARE: THERAWELL MEDICAL GROUP PLLC

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
1	363LC1500X	Community Health Nurse Practitioner

General Provider Information

NPI Number	:	1215781950
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAWELL MEDICAL GROUP PLLC

Provider Business Mailing Address
First Line	:	23414 BAKER HILL DR
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-2567
Country	:	US
Telephone Number	:	346-613-0227
Fax Number	:

Provider Business Practice Location Address
First Line	:	23414 BAKER HILL DR
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-2567
Country	:	US
Telephone Number	:	346-613-0227
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DORCAS AYANGA
Credential	:	NP
Telephone Number	:	346-613-0227

Provider Enumeration Date	:	04/17/2024
Last Update Date	:	05/05/2024

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