MEDICARE: PECULIAR WELLNESS CENTER LLC

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	:	1659542967
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PECULIAR WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	1030 S CARRIER PKWY STE 100
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75051-1527
Country	:	US
Telephone Number	:	469-373-2260
Fax Number	:	469-208-9291

Provider Business Practice Location Address
First Line	:	1030 S CARRIER PKWY STE 100
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75051-1527
Country	:	US
Telephone Number	:	469-373-2260
Fax Number	:	469-208-9291

Authorized Official
Title or Position	:	CEO
Name	:	ANTHONIA DURU
Credential	:	NP
Telephone Number	:	469-373-2260

Provider Enumeration Date	:	03/13/2008
Last Update Date	:	06/02/2026

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