National Provider Identifier Database

ADVANCED WELLNESS INFUSION CENTER LLC
Infusion Therapy


Contact Information

ADVANCED WELLNESS INFUSION CENTER, LLC
5805 E COLUMBUS WAY
WASILLA, AK99654-7831
Phone: 907-929-4825
Fax:
Website:
Specialty Taxonomy Code
* Infusion Therapy 261QI0500X

* Indicates primary specialty

NPI Profile & details for ADVANCED WELLNESS INFUSION CENTER, LLC

NPI Number 1366112856
Legal business name
LBN
ADVANCED WELLNESS INFUSION CENTER, LLC
Authorized official NATHANIEL EASTMAN - (OWNER/PROVIDER)
Entity Organization
Organization subpart No
Enumeration date 09/15/2021
Last updated 03/07/2023 - About 3 years ago
Sole proprietor1 Not specified
Identifiers
  • AK Other: MEDS5780 STATE OF ALASKA MEDICAL LICENSE

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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