Provider Demographics
NPI:1316613037
Name:WOMEN'S WELLNESS CLINIC
Entity type:Organization
Organization Name:WOMEN'S WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:765-393-1965
Mailing Address - Street 1:2705 ENTERPRISE DR # 5
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46013-9670
Mailing Address - Country:US
Mailing Address - Phone:765-393-1965
Mailing Address - Fax:
Practice Address - Street 1:2705 ENTERPRISE DR # 5
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46013-9670
Practice Address - Country:US
Practice Address - Phone:765-393-1965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-22
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty