Provider Demographics
NPI:1205495793
Name:WELLNESS FOR WOMEN PLLC
Entity type:Organization
Organization Name:WELLNESS FOR WOMEN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:DRIES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-467-5588
Mailing Address - Street 1:94C WHITTEN HILL RD
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04046-5114
Mailing Address - Country:US
Mailing Address - Phone:207-467-5588
Mailing Address - Fax:
Practice Address - Street 1:50 PORTLAND RD STE 4
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6789
Practice Address - Country:US
Practice Address - Phone:207-502-7400
Practice Address - Fax:207-569-0012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-10
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME433002499Medicaid