MEDICARE: ABUNDANT 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
1	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1629548359
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABUNDANT WELLNESS

Provider Business Mailing Address
First Line	:	101 W WASHINGTON ST STE C1
Second Line	:
City	:	RIDGELAND
State	:	MS
Zip	:	39157-2434
Country	:	US
Telephone Number	:	601-856-2383
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 W WASHINGTON ST STE C1
Second Line	:
City	:	RIDGELAND
State	:	MS
Zip	:	39157-2434
Country	:	US
Telephone Number	:	601-856-2383
Fax Number	:

Authorized Official
Title or Position	:	FNP
Name	:	DANA GERMANY
Credential	:
Telephone Number	:	601-527-4659

Provider Enumeration Date	:	11/26/2018
Last Update Date	:	02/27/2020

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Directions to “ABUNDANT WELLNESS ” Practice Location

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