# THE WELLNESS COOPERATIVE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184340291
- **Authorized official:** TONYA LEE FREDERICK APRN (FOUNDING MEMBER, FNP-C)
- **Authorized official phone:** (503) 791-2816

## Contact information

- **Practice address:** 714 HARRISON AVE, ASTORIA, OR 97103-4738
- **Practice address phone:** (503) 791-2816
- **Practice address fax:** (866) 638-1928
- **Mailing address:** 714 HARRISON AVE, ASTORIA, OR 97103-4738
- **Mailing address phone:** (503) 791-2816
- **Mailing address fax:** (866) 638-1928

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/19/2022
- **Last updated:** 10/19/2022