Provider Demographics
NPI:1487413340
Name:LONESTAR INTIMATE WELLNESS PLLC
Entity type:Organization
Organization Name:LONESTAR INTIMATE WELLNESS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WELSEY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-442-0055
Mailing Address - Street 1:8201 PRESTON RD STE 520
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-6210
Mailing Address - Country:US
Mailing Address - Phone:214-442-0055
Mailing Address - Fax:214-442-0056
Practice Address - Street 1:8201 PRESTON RD STE 520
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6210
Practice Address - Country:US
Practice Address - Phone:214-442-0055
Practice Address - Fax:214-442-0056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-14
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty