WHOLELIFE FAMILY WELLNESS CLINIC OF PROVIDENCE PLLC (NPI# 1962049932) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962049932 |
| Entity Type | Organization |
| Organization Name | WHOLELIFE FAMILY WELLNESS CLINIC OF PROVIDENCE PLLC |
| Practice Address |
169 N Gateway Dr. Suite 170 Providence UT 84332 |
| Mailing Address |
274 N Main St Logan UT 84321-3915 |
| Practice Telephone | 4352133597 |
| Mailing Telephone | 4357531600 |
| Mailing Fax Number | 4357539521 |
| Enumeration Date | 2019-12-09 |
| Last Update Date | 2020-03-13 |
| Authorized Official Name | NATALIE JEAN GIBSON (CO-OWNER) |
| Authorized Official Telephone | 4352133597 |
| Authorized Official Credential | APRN, FNP-C, DNP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers | ||
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
169 N GATEWAY DR. SUITE 170 |
| City | PROVIDENCE |
| State | UT |
| Zip Code | 84332 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881292167 | 3bc Incorporated | Pharmacy | 435 North Gateway Drive #802, Providence, UT 84332 | 2020-10-09 |
| 1033503420 | Spring Creek Surgical Center, LLC | Clinic/Center | 65 North Gateway Drive, Suite 3, Providence, UT 84332 | 2015-03-24 |
| 1558751438 | Naturopathic Medical, P.C. | Naturopath | 565 W. 465 N., Suite 150, Providence, UT 84332 | 2015-01-29 |
| 1821421710 | Erin Campbell | Physical Therapist | 267 West Spring Creek Parkway, Providence, UT 84332 | 2013-08-14 |
| 1285981530 | Jordan Joseph Hansen | Dentist | 169 N Gateway Drive, Suite 200, Providence, UT 84332 | 2012-08-06 |
| 1598086720 | Cory B Maughan | Dermatology | 169 N Gateway Dr Ste 100, Providence, UT 84332 | 2010-06-22 |
| 1528299245 | South Valley Eyecare Center, Inc. | Optometrist | 276 Springcreek Pkwy, Providence, UT 84332 | 2009-07-29 |
| 1316134356 | Heather Saxton Maughan | Speech-Language Pathologist | 344 E Edgehill Dr, Providence, UT 84332 | 2007-10-03 |
| 1902021538 | Brad L Thomas | Physical Therapist | 169 Spring Creek Park Way, Suite 140, Providnce, UT 84332 | 2007-04-17 |
| 1558495457 | Maceys Inc | Pharmacy | 50 North Highway 165, Providence, UT 84332 | 2007-03-15 |
| Find all providers in zip 84332 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154933984 | Sarah Jane France | Nurse Practitioner | 1 Randall Sq Ste 409, Providence, RI 02904-7405 | 2020-08-22 |
| 1225664386 | Monica A Harris | Nurse Practitioner | 1078 S 800 E, Providence, UT 84332-2400 | 2020-03-20 |
| 1669008728 | Sean Andrew Rebello | Nurse Practitioner | 180 Corliss St Ste E, Providence, RI 02904-2602 | 2020-03-19 |
| 1902456270 | Nelsy Robles Colon | Nurse Practitioner | 1 Randall Sq Ste 205, Providence, RI 02904-2773 | 2019-09-18 |
| 1518511021 | Effiem Obasi | Nurse Practitioner | 143 Longwood Ave, Providence, RI 02908-1121 | 2019-08-01 |
| 1861056608 | Temperance Taylor | Nurse Practitioner | 222 Dora St Apt 1, Providence, RI 02909-3824 | 2019-04-26 |
| 1790240141 | Miriannys Rivas | Nurse Practitioner | 170 Rhodes St, Providence, RI 02903-4919 | 2019-02-08 |
| 1962970947 | Wesley Irish | Nurse Practitioner | 21 Pekin St, Providence, RI 02908-3716 | 2018-11-07 |
| 1902317449 | Ashley Lynn Wright | Nurse Practitioner | 120 Dudley St Ste 104, Providence, RI 02905-2431 | 2017-10-23 |
| 1699216226 | Julie L'europa | Nurse Practitioner | 1085 North Main Street, Providence, RI 02904-7426 | 2017-03-15 |
| Find all providers in PROVIDENCE | ||||
| City | PROVIDENCE |
| Zip Code | 84332 |
Please comment or provide details below to improve the information on WHOLELIFE FAMILY WELLNESS CLINIC OF PROVIDENCE PLLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.