MEDICARE: BASIC WELLNESS 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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1962393025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BASIC WELLNESS LLC

Provider Business Mailing Address
First Line	:	4 KERRY LN
Second Line	:
City	:	NORTH EASTON
State	:	MA
Zip	:	02356-1762
Country	:	US
Telephone Number	:	617-875-5221
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 KERRY LN
Second Line	:
City	:	NORTH EASTON
State	:	MA
Zip	:	02356-1762
Country	:	US
Telephone Number	:	617-875-5221
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	MRS. TITILAYO TRACEY WESTOVER
Credential	:	NP
Telephone Number	:	617-875-5221

Provider Enumeration Date	:	07/15/2025
Last Update Date	:	04/03/2026

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