Provider Demographics
NPI:1912737537
Name:NENAWELLNESS LLC
Entity type:Organization
Organization Name:NENAWELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMSTELVEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-472-4279
Mailing Address - Street 1:191 SUNNYBROOK LN
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-5567
Mailing Address - Country:US
Mailing Address - Phone:904-472-4279
Mailing Address - Fax:
Practice Address - Street 1:3401 UNIVERSITY DR STE 9
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2656
Practice Address - Country:US
Practice Address - Phone:919-730-4542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty