Provider Demographics
NPI:1194484600
Name:WELLNESS FAMILY MEDICINE, PC
Entity type:Organization
Organization Name:WELLNESS FAMILY MEDICINE, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MELBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-768-9490
Mailing Address - Street 1:1674 EL CAPITAN DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2974
Mailing Address - Country:US
Mailing Address - Phone:530-768-9490
Mailing Address - Fax:
Practice Address - Street 1:760 CYPRESS AVE STE 300
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2743
Practice Address - Country:US
Practice Address - Phone:530-768-9490
Practice Address - Fax:530-653-2150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-12
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty