Provider Demographics
NPI:1972268886
Name:DENALI HEALTH & WELLNESS
Entity type:Organization
Organization Name:DENALI HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/APRN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MACRESIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRAZIEL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:772-607-0127
Mailing Address - Street 1:10380 SW VILLAGE CENTER DR STE 223
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-1931
Mailing Address - Country:US
Mailing Address - Phone:772-607-0127
Mailing Address - Fax:
Practice Address - Street 1:185 SW BEDFORD RD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-6937
Practice Address - Country:US
Practice Address - Phone:772-607-0127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care