Organization
PREMIUM WELLNESS AND PRIMARY CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MONICA DIANNE ZELLOUS (PRACTICE MANAGER)
(336) 553-0793
Entity
Organization
Contact information
Practice address
308 POMONA DR STE A, GREENSBORO, NC 27407-1644
(336) 553-0793
Mailing address
308 POMONA DR STE A, GREENSBORO, NC 27407-1644
(336) 553-0793
(336) 553-0795
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
5004483
NC
261QH0100X
Health Service Clinic/Center
5006433
NC
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8975633
—
NC
Enumeration date
06/18/2016
Last updated
07/12/2024
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