Provider Demographics
NPI:1962823716
Name:WELLNESS CARE NURSE REGISTRY INC
Entity type:Organization
Organization Name:WELLNESS CARE NURSE REGISTRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAING
Authorized Official - Middle Name:
Authorized Official - Last Name:BEVERLY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:239-645-4764
Mailing Address - Street 1:3305 35TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33976-4305
Mailing Address - Country:US
Mailing Address - Phone:239-645-4764
Mailing Address - Fax:239-303-2859
Practice Address - Street 1:3305 35TH ST SW
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33976-4305
Practice Address - Country:US
Practice Address - Phone:239-645-4764
Practice Address - Fax:239-303-2859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211684251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care