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NPI Code Detail

MEDICARE: BALANCED WELLNESS

MEDICARE: BALANCED WELLNESS
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
1363L00000XNurse Practitioner

General Provider Information

NPI Number : 1396447785
Entity Type Code : Organization
Provider Name (Legal Business Name) : BALANCED WELLNESS
Provider Business Mailing Address
First Line : 1309 COFFEEN AVE STE 1200
Second Line :
City : SHERIDAN
State : WY
Zip : 82801-5777
Country : US
Telephone Number : 260-445-7080
Fax Number :
Provider Business Practice Location Address
First Line : 334 N SENATE AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46204-1708
Country : US
Telephone Number : 260-445-7080
Fax Number :
Authorized Official
Title or Position : NURSE PRACTITIONER, OWNER
Name : ROSE WILCOX
Credential : NP
Telephone Number : 260-445-7080
Provider Enumeration Date : 03/20/2023
Last Update Date : 03/20/2023

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Directions to “BALANCED WELLNESS ” Practice Location

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