Organization
WHOLELIFE FAMILY WELLNESS CLINIC OF PROVIDENCE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NATALIE JEAN GIBSON APRN, FNP-C, DNP (CO-OWNER)
(435) 213-3597
Entity
Organization
Contact information
Practice address
169 N GATEWAY DR. SUITE 170, PROVIDENCE, UT 84332
(435) 213-3597
Mailing address
274 N MAIN ST, LOGAN, UT 84321-3915
(435) 753-1600
(435) 753-9521
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
12/09/2019
Last updated
03/13/2020
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