Organization
ENVISION INTEGRATIVE SERVICES
Active
Parent organization
BE WELL ADULT, NP, PPLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
BE WELL ADULT, NP, PPLC
Authorized official
NICOLE FLEMMING CPC,CRC,CPB,CBCS,CMA (BILLING AND CREDENTIALING MANAGER)
(843) 640-9342
Entity
Organization
Contact information
Practice address
1461 LAKELAND AVE UNIT 9, BOHEMIA, NY 11716-2174
(631) 467-8224
(631) 585-7575
Mailing address
1461 LAKELAND AVE UNIT 9, BOHEMIA, NY 11716-2174
(631) 467-8224
(631) 585-7575
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
—
—
363L00000X
Nurse Practitioner
Primary
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
Other
Enumeration date
01/24/2024
Last updated
03/28/2024
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