Organization
LIFE MOBILE WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAVARE SELTUN FNP-C (MANAGER)
(980) 745-2195
Entity
Organization
Contact information
Practice address
4324 STONE MOUNTAIN DRIVE, GASTONIA, NC 28054
(984) 279-0776
Mailing address
1235 EAST BLVD STE E, CHARLOTTE, NC 28203-5876
(980) 246-1342
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Enumeration date
06/27/2023
Last updated
08/27/2024
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