Provider Demographics
NPI:1487968194
Name:LIVEWELL FAMILY HEALTH, PC
Entity type:Organization
Organization Name:LIVEWELL FAMILY HEALTH, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENDALL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:276-328-2961
Mailing Address - Street 1:PO BOX 3077
Mailing Address - Street 2:
Mailing Address - City:WISE
Mailing Address - State:VA
Mailing Address - Zip Code:24293-3077
Mailing Address - Country:US
Mailing Address - Phone:276-328-2961
Mailing Address - Fax:276-328-2965
Practice Address - Street 1:517 W MAIN ST
Practice Address - Street 2:SUITE E
Practice Address - City:WISE
Practice Address - State:VA
Practice Address - Zip Code:24293-6905
Practice Address - Country:US
Practice Address - Phone:276-328-2961
Practice Address - Fax:276-328-2965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-05
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty