Xenon Wellness, LLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

XENON WELLNESS, LLC

Practice address

810 Marvin LN
Green Bay, WI 54311-5944

Phone

(920) 857-8112

NPI assigned

May 17, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tabitha Bea Wallenfang

Title

Owner

Phone

(920) 857-8112

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1621209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621209600000",
    "number": "1285208918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 MARVIN LN",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543115944",
            "telephone_number": "920-857-8112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 MARVIN LN",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543115944",
            "telephone_number": "920-857-8112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "XENON WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-17",
        "last_updated": "2021-05-17",
        "certification_date": "2021-05-17",
        "status": "A",
        "authorized_official_last_name": "WALLENFANG",
        "authorized_official_first_name": "TABITHA",
        "authorized_official_middle_name": "BEA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-857-8112"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatry Physician in Green Bay, WI
• Providers in Green Bay, WI by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.