Provider Demographics
NPI:1962262527
Name:BRINATA WELLNESS LLC
Entity type:Organization
Organization Name:BRINATA WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:
Authorized Official - Last Name:TANUI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:816-726-1289
Mailing Address - Street 1:2413 SW WOODHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-4079
Mailing Address - Country:US
Mailing Address - Phone:816-726-1289
Mailing Address - Fax:
Practice Address - Street 1:2413 SW WOODHAVEN LN
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64082-4079
Practice Address - Country:US
Practice Address - Phone:816-726-1289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty