MEDICARE: HEALTHCO EXECUTIVE 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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1578403184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHCO EXECUTIVE WELLNESS PLLC

Provider Business Mailing Address
First Line	:	1401 W JEFFERSON BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-5326
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 W JEFFERSON BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-5326
Country	:	US
Telephone Number	:	469-708-7454
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	NENNA NWAZOTA
Credential	:
Telephone Number	:	469-708-7454

Provider Enumeration Date	:	03/31/2026
Last Update Date	:	04/01/2026

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Directions to “HEALTHCO EXECUTIVE WELLNESS PLLC ” Practice Location

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