Provider Demographics
NPI:1447039292
Name:NORTH STAR WELLNESS
Entity type:Organization
Organization Name:NORTH STAR WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNIER
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:860-249-1824
Mailing Address - Street 1:34 N STAR DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-3858
Mailing Address - Country:US
Mailing Address - Phone:860-249-1824
Mailing Address - Fax:833-350-2636
Practice Address - Street 1:34 N STAR DR
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-3858
Practice Address - Country:US
Practice Address - Phone:860-249-1824
Practice Address - Fax:833-350-2636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health