Provider Demographics
NPI:1396507752
Name:INTEGRATED WELLNESS PLLC
Entity type:Organization
Organization Name:INTEGRATED WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANI
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:406-270-6638
Mailing Address - Street 1:604 PINE PL
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-2362
Mailing Address - Country:US
Mailing Address - Phone:406-270-6638
Mailing Address - Fax:
Practice Address - Street 1:431 1ST AVE W STE 4
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4959
Practice Address - Country:US
Practice Address - Phone:406-219-7874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-30
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine