# PRESQUE ISLE MIND-BODY WELLNESS CENTER, PLLC

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

## Provider details

- **NPI number:** 1467096164
- **Authorized official:** KELLY WEARY (MANAGER)
- **Authorized official phone:** (814) 860-3179

## Contact information

- **Practice address:** 2500 PALERMO DR, ERIE, PA 16506-7206
- **Practice address phone:** (814) 860-3179
- **Practice address fax:** (814) 616-7400
- **Mailing address:** 2500 PALERMO DR, ERIE, PA 16506-7206
- **Mailing address phone:** (814) 860-3179
- **Mailing address fax:** (814) 616-7400

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163W00000X | Registered Nurse | — | NULL | — |
| 163W00000X | Registered Nurse | — | — | — |
| 163WP0809X | Adult Psychiatric/Mental Health Registered Nurse | — | NULL | Yes |
| 163WP0809X | Adult Psychiatric/Mental Health Registered Nurse | — | — | Yes |
| 2084P0800X | Psychiatry Physician | — | NULL | — |
| 2084P0800X | Psychiatry Physician | — | — | — |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | NULL | — |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 11/05/2019
- **Last updated:** 02/15/2022