Provider Demographics
NPI:1699548560
Name:CROWN WELLNESS INTEGRATED HEALTH
Entity type:Organization
Organization Name:CROWN WELLNESS INTEGRATED HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORZIED OFFICIAL
Authorized Official - Prefix:MS
Authorized Official - First Name:IFEANULI
Authorized Official - Middle Name:
Authorized Official - Last Name:ONA
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:862-357-5834
Mailing Address - Street 1:118 FAIRCHILD AVE
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-1707
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:118 FAIRCHILD AVE
Practice Address - Street 2:
Practice Address - City:MORRIS PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07950-1707
Practice Address - Country:US
Practice Address - Phone:862-357-5834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty