Provider Demographics
NPI:1053129635
Name:WELLNESS COMMUNITY NURSING LLC
Entity type:Organization
Organization Name:WELLNESS COMMUNITY NURSING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:JEMIMAH
Authorized Official - Middle Name:MANZANO
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-227-0028
Mailing Address - Street 1:619 N OAK HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-7475
Mailing Address - Country:US
Mailing Address - Phone:971-227-0028
Mailing Address - Fax:
Practice Address - Street 1:619 N OAK HOLLOW DR
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-7475
Practice Address - Country:US
Practice Address - Phone:971-227-0028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-27
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty