Provider Demographics
NPI:1851100432
Name:TEQUILA'S WHOLE HEALTH, LLC
Entity type:Organization
Organization Name:TEQUILA'S WHOLE HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TEQUILA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-BC
Authorized Official - Phone:304-573-1992
Mailing Address - Street 1:4875 KIETZKE LN STE 200A-22
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6587
Mailing Address - Country:US
Mailing Address - Phone:304-573-1992
Mailing Address - Fax:
Practice Address - Street 1:4875 KIETZKE LN STE 200A-22
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6587
Practice Address - Country:US
Practice Address - Phone:304-573-1992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty