Provider Demographics
NPI:1194482778
Name:VAN HEALTH AND WELLNESS, PLLC
Entity type:Organization
Organization Name:VAN HEALTH AND WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:ANP-C
Authorized Official - Phone:903-368-0414
Mailing Address - Street 1:2299 VZ COUNTY ROAD 4909
Mailing Address - Street 2:
Mailing Address - City:BEN WHEELER
Mailing Address - State:TX
Mailing Address - Zip Code:75754-4220
Mailing Address - Country:US
Mailing Address - Phone:903-368-0414
Mailing Address - Fax:
Practice Address - Street 1:488 W. MAIN STREET
Practice Address - Street 2:
Practice Address - City:VAN
Practice Address - State:TX
Practice Address - Zip Code:75790
Practice Address - Country:US
Practice Address - Phone:903-963-6850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center