Organization
PREMIUM WELLNESS AND PRIMARY CARE
Active
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
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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