Ketamine Wellness Infusions PA LLC
Nurse Anesthetist, Certified Registered in Bala Cynwyd, PA. Organization (NPI-2).
NPI number1629830005
StatusActive
Last updated in NPPESMar 12, 2024
Details
- NPI
- 1629830005
- Entity type
- Organization (NPI-2)
- Legal business name
- Ketamine Wellness Infusions PA LLC
- Organization subpart
- No
- Enumeration date
- Jan 30, 2024
- Certification date
- Mar 12, 2024
- Last updated
- Mar 12, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | – | – | Yes |
Practice location
146 Montgomery Ave Ste 202Bala Cynwyd, PA 19004-2956
Phone 484-434-9633
Mailing address
146 Montgomery Ave Ste 202Bala Cynwyd, PA 19004-2956
Phone 484-434-8963
Authorized official
Jill Gabay
Medical Director
4844348963
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