At Peace Wellness LLC
Organization Active NPI Nurse Practitioner · Willow Grove, PA
NPI 1407437692 · NPPES record last updated Jan 31, 2025
Key facts
- NPI
- 1407437692
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Nurse Practitioner 363L00000X
- Legal business name
- AT PEACE WELLNESS LLC
- Practice address
- 1001 Easton Rd Ste 104
Willow Grove, PA 19090-2037 - Phone
- (267) 403-1475
- Fax
- (877) 866-2051
- NPI assigned
- Apr 19, 2021
- Organization subpart
- No
Authorized official
- Name
- Ebony Chatmon, NURSE PRACTITIONER
- Title
- Owner
- Phone
- (267) 264-8926
Practitioners 3
-
Felicia Ngozl Anyanwu, CRNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in PA, FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240202003373 | PA | Part B Supplier - Clinic/Group Practice | 0749623056 |
Receives reassigned benefits from 3 practitioners Practice locations: Willow Grove, PA |
| O20250206000677 | FL | Part B Supplier - Clinic/Group Practice | 0749623056 |
Receives reassigned benefits from 1 practitioner Practice locations: Tarpon Springs, FL |
National Provider Directory
Locations
1501 S Pinellas Ave
Ste A
Tarpon Springs, FL 34689
Phone (267) 403-1475
1001 Easton Rd
Ste 104
Willow Grove, PA 19090
Phone (215) 658-1618
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner |
363L00000X | Yes |
Addresses
Primary practice location
1001 Easton Rd Ste 104
Willow Grove, PA 19090-2037
Mailing address
PO Box 29718
Elkins Park, PA 19027-0918
Phone (267) 403-1475
Other practice location 1
1501 S Pinellas Ave Ste A
Tarpon Springs, FL 34689-1950
Phone (267) 403-1475
Other practice location 2
376 2nd Street Pike
Southampton, PA 18966-3834
Phone (215) 315-8665
Other names
- AFFINITY WELL SPA
Other providers in Willow Grove, PA
- Ann Plenderleith, LCSW
- Marina Lynn Antinozzi
- Anthony C Anzalone
- Robert Arnold
- Ask Pharmacy LLC
- Atlantic Health Care PLLC
- Shahodat Azimova
- Orna Kempler Azulay
- Yuval Azulay
- Azzatori Chiropractic of Willow Grove
All providers in Willow Grove, PA · Nurse Practitioner in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 31, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.