Organization Name: | WC WELLNESS LLC |
NPI Number: | 1013147834 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PHIL DETOURNILLON (TREASURER) |
Mailing Address: | 600 Sw 3rd St Suite 2270 Pompano Beach |
State: | FL US |
Postal Code: | 330606932 |
Phone Number: | 9542410303 |
Fax Number: | |
NPI Enumeration Date: | 07/15/2009 |
NPI Last Update Date: | 07/15/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0808X |
License Number: | ARNP1348922 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | FL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Psych/Mental Health |
Taxonomy Definition: |