| Live Well Integrative Health And Services, Llc | |
|
7683 Wyldwood Way Port Saint Lucie FL 34986-3008 | |
| (772) 216-3546 | |
| Not Available |
| Full Name | Live Well Integrative Health And Services, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 7683 Wyldwood Way, Port Saint Lucie, Florida |
| Authorized Official Name and Position | Danielle Elizabeth Stephens (OWNER) |
| Authorized Official Contact | 7722163546 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Live Well Integrative Health And Services, Llc 7683 Wyldwood Way Port Saint Lucie FL 34986-3008 Ph: (772) 216-3546 | Live Well Integrative Health And Services, Llc 7683 Wyldwood Way Port Saint Lucie FL 34986-3008 Ph: (772) 216-3546 |
| NPI Number | 1760298004 |
|---|---|
| Provider Enumeration Date | 12/10/2024 |
| Last Update Date | 12/10/2024 |
| Medicare PECOS PAC ID | 2769918812 |
|---|---|
| Medicare Enrollment ID | O20241212000892 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760298004 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | (* (Not Available)) | Primary |
| Provider Name | Danielle E Stephens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528200367 PECOS PAC ID: 7416002779 Enrollment ID: I20090910000209 |
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