Organization
WELLNESS IN THE GOLDEN YEARS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HOLLY PORTILLO NURSE PRACTITIONER (MANAGER/CO-OWNER)
(254) 721-2563
Entity
Organization
Contact information
Practice address
421 W EST MAIN STREET, ROSEBUD, TX 76570
(254) 721-2563
Mailing address
PO BOX 64, ROSEBUD, TX 76570-0064
(254) 721-2563
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
03/09/2018
Last updated
07/27/2018
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