ADVANCED WELLNESS INFUSION CENTER, LLC; NPI #1366112856

Contact Information

ADVANCED WELLNESS INFUSION CENTER, LLC

5805 E COLUMBUS WAY
WASILLA, AK 99654-7831

Phone: 907-929-4825
Fax:
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Infusion Therapy	261QI0500X

Indicates primary specialty

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NPI Profile & details for ADVANCED WELLNESS INFUSION CENTER, LLC

NPI Number 1366112856

LBN Legal business name ADVANCED WELLNESS INFUSION CENTER, LLC

Authorized official NATHANIEL EASTMAN - (OWNER/PROVIDER)

Entity Organization

Organization subpart ¹ No

Enumeration date 09/15/2021

Last updated 03/07/2023 - About 3 years ago

Identifiers

Other

MEDS5780

STATE OF ALASKA MEDICAL LICENSE

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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