MEDICARE: NUGLOW WELLNESS CENTER

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
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1689423006
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUGLOW WELLNESS CENTER

Provider Business Mailing Address
First Line	:	6282 IRVINE BLVD STE 36
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92620-2103
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6282 IRVINE BLVD STE 36
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92620-2103
Country	:	US
Telephone Number	:	949-866-8818
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EVANGELINE NADEAU
Credential	:
Telephone Number	:	949-866-8818

Provider Enumeration Date	:	05/16/2024
Last Update Date	:	05/16/2024

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Directions to “NUGLOW WELLNESS CENTER ” Practice Location

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