Provider Demographics
NPI:1972090181
Name:BLUE APPLE WELLNESS, LLP
Entity type:Organization
Organization Name:BLUE APPLE WELLNESS, LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:WADE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DARR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-600-5039
Mailing Address - Street 1:1650 45TH ST S STE 113
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-3247
Mailing Address - Country:US
Mailing Address - Phone:701-532-0397
Mailing Address - Fax:701-540-0409
Practice Address - Street 1:1650 45TH ST S STE 113
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3247
Practice Address - Country:US
Practice Address - Phone:701-532-0397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLUE APPLE WELLNESS, LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-13
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND643261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service