MEDICARE: GREATER GOOD WELLNESS 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1295666824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER GOOD WELLNESS PLLC

Provider Business Mailing Address
First Line	:	818 E WILEY WAY
Second Line	:
City	:	CASA GRANDE
State	:	AZ
Zip	:	85122-1218
Country	:	US
Telephone Number	:	520-371-0846
Fax Number	:

Provider Business Practice Location Address
First Line	:	818 E WILEY WAY
Second Line	:
City	:	CASA GRANDE
State	:	AZ
Zip	:	85122-1218
Country	:	US
Telephone Number	:	520-371-0846
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KWESI IMMANUEL
Credential	:	PMHNP
Telephone Number	:	520-371-0846

Provider Enumeration Date	:	05/25/2026
Last Update Date	:	05/25/2026

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Directions to “GREATER GOOD WELLNESS PLLC ” Practice Location

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