Organization
FIRST LADY WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH A HOLMES AGNP-BC (NURSE PRACTITIONER)
(503) 447-6886
Entity
Organization
Contact information
Practice address
314 NE 19TH AVE, PORTLAND, OR 97232-2829
(415) 999-2792
Mailing address
2623 9TH AVE, OAKLAND, CA 94606-2127
(415) 999-2792
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
—
—
163W00000X
Registered Nurse
—
—
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
07/29/2024
Last updated
07/29/2024
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