Provider Demographics
NPI:1992573042
Name:PRIMAL INFUSIONS AND WELLNESS
Entity type:Organization
Organization Name:PRIMAL INFUSIONS AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAKYLA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WENDROTH
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:641-691-8874
Mailing Address - Street 1:10455 165TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:BECKER
Mailing Address - State:MN
Mailing Address - Zip Code:55308-4110
Mailing Address - Country:US
Mailing Address - Phone:641-691-8874
Mailing Address - Fax:
Practice Address - Street 1:10455 165TH AVE SE
Practice Address - Street 2:
Practice Address - City:BECKER
Practice Address - State:MN
Practice Address - Zip Code:55308-4110
Practice Address - Country:US
Practice Address - Phone:641-691-8874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No251F00000XAgenciesHome Infusion
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy