Provider Demographics
NPI:1982118899
Name:MW WELLNESS I, LLC
Entity type:Organization
Organization Name:MW WELLNESS I, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF INSURANCE
Authorized Official - Prefix:
Authorized Official - First Name:WENDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NONCLERC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-228-6334
Mailing Address - Street 1:4930 FRUITVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-2206
Mailing Address - Country:US
Mailing Address - Phone:813-228-6334
Mailing Address - Fax:
Practice Address - Street 1:4930 FRUITVILLE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-2206
Practice Address - Country:US
Practice Address - Phone:813-228-6334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SARASOTA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty