Provider Demographics
NPI:1144892068
Name:WOMEN'S HOLISTIC WELLNESS LLC
Entity type:Organization
Organization Name:WOMEN'S HOLISTIC WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WOMEN'S HEALTH NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIKHONOV
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:908-217-0916
Mailing Address - Street 1:122 OLD POST RD
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-3149
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:122 OLD POST RD
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-3149
Practice Address - Country:US
Practice Address - Phone:908-217-0916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty