Provider Demographics
NPI:1316768195
Name:MOUNTAINVIEW WELLNESS CENTER LLC
Entity type:Organization
Organization Name:MOUNTAINVIEW WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PA-C
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:TITCHNELL
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:304-276-0735
Mailing Address - Street 1:1223 NATIONAL HWY
Mailing Address - Street 2:
Mailing Address - City:LAVALE
Mailing Address - State:MD
Mailing Address - Zip Code:21502-7602
Mailing Address - Country:US
Mailing Address - Phone:304-276-0735
Mailing Address - Fax:240-293-4796
Practice Address - Street 1:1223 NATIONAL HWY
Practice Address - Street 2:
Practice Address - City:LAVALE
Practice Address - State:MD
Practice Address - Zip Code:21502-7602
Practice Address - Country:US
Practice Address - Phone:304-276-0735
Practice Address - Fax:240-293-4796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty