Provider Demographics
NPI:1528525359
Name:MEDICAL WELLNESS CLINIC
Entity type:Organization
Organization Name:MEDICAL WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:SPROUSE-TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:828-659-9355
Mailing Address - Street 1:79 ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-3901
Mailing Address - Country:US
Mailing Address - Phone:828-659-9355
Mailing Address - Fax:828-659-6334
Practice Address - Street 1:79 ACADEMY ST STE D
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-3901
Practice Address - Country:US
Practice Address - Phone:828-659-9355
Practice Address - Fax:828-659-6334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty