Provider Demographics
NPI:1972319382
Name:PAULVITAL WELLNESS
Entity type:Organization
Organization Name:PAULVITAL WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PERRY PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPINOSA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:701-730-6603
Mailing Address - Street 1:2900 34TH AVE S APT 1138
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-5184
Mailing Address - Country:US
Mailing Address - Phone:701-730-6603
Mailing Address - Fax:
Practice Address - Street 1:2900 34TH AVE S APT 1138
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-5184
Practice Address - Country:US
Practice Address - Phone:701-730-6603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-10
Last Update Date:2024-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty