| Organization Name: | MONTCLAIR HEALTH AND WELLNESS LLC |
| NPI Number: | 1013216498 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | EDITH A WILES (OFFICE MANAGER) |
| Mailing Address: | 710 Cornersville Rd Lewisburg |
| State: | TN US |
| Postal Code: | 37091 |
| Phone Number: | 9319945717 |
| Fax Number: | 9312464233 |
| NPI Enumeration Date: | 03/24/2011 |
| NPI Last Update Date: | 05/01/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | APN0000006822 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |