MEDICARE: WELLNESS &HEALTH CLINIC INC

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	261QP2300X	Primary Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	804817310	OTHER	TX	FAMILY NURSE PRACTITIONER

General Provider Information

NPI Number	:	1265142947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS &HEALTH CLINIC INC

Provider Business Mailing Address
First Line	:	3435 HIGHLAND RD STE 105
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-7165
Country	:	US
Telephone Number	:
Fax Number	:	972-686-3825

Provider Business Practice Location Address
First Line	:	3435 HIGHLAND RD STE 105
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-7165
Country	:	US
Telephone Number	:	469-231-3711
Fax Number	:	972-686-3825

Authorized Official
Title or Position	:	FAMILY NURSE PRACTITIONER
Name	:	GLORIA NWEKE
Credential	:
Telephone Number	:	469-878-2511

Provider Enumeration Date	:	12/02/2022
Last Update Date	:	12/02/2022

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Directions to “WELLNESS &HEALTH CLINIC INC ” Practice Location

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