Organization
XENON WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TABITHA BEA WALLENFANG (OWNER)
(920) 857-8112
Entity
Organization
Contact information
Practice address
810 MARVIN LN, GREEN BAY, WI 54311-5944
(920) 857-8112
Mailing address
810 MARVIN LN, GREEN BAY, WI 54311-5944
(920) 857-8112
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Enumeration date
05/17/2021
Last updated
05/17/2021
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