Provider Demographics
NPI:1558184028
Name:ENDOCARE WELLNESS PLLC
Entity type:Organization
Organization Name:ENDOCARE WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:NATASHA
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-816-1010
Mailing Address - Street 1:3886 W TENACITY CIR
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-1652
Mailing Address - Country:US
Mailing Address - Phone:801-603-5648
Mailing Address - Fax:
Practice Address - Street 1:3886 W TENACITY CIR
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-1652
Practice Address - Country:US
Practice Address - Phone:801-603-5648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-04
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty