NPIMap

Organization Active NPI

Wellnite Medical Group PA

  • Neurology Physician
  • Nampa, ID
National Provider Identifier
1417739038
Registry record updated Oct 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
WELLNITE MEDICAL GROUP PA
Practice address
1105 2ND St S
Nampa, ID 83651-3911
Phone
(650) 761-9770
NPI assigned
Oct 18, 2023
Last updated
Oct 18, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2023

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

Authorized official

Name
Elisa Swan
Title
Ceo
Phone
(855) 731-1410

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X NU Primary

Addresses

Primary practice location

1105 2ND St S
Nampa, ID 83651-3911

Mailing address

2261 Market St # 4058
San Francisco, CA 94114-1612
Phone (855) 731-1410

National Provider Directory

National Provider Directory
Tax ID family
Wellnite Medical Group PA47 organizations share this tax ID, including this one

Other organizations with this tax ID 46

Organizations that report the same tax identification number in the National Provider Directory.

View all 46

NPI Registry JSON

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

{
    "created_epoch": "1697587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697587200000",
    "number": "1417739038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2261 MARKET ST # 4058",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941141612",
            "telephone_number": "855-731-1410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 2ND ST S",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836513911",
            "telephone_number": "650-761-9770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLNITE MEDICAL GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-18",
        "last_updated": "2023-10-18",
        "certification_date": "2023-10-18",
        "status": "A",
        "authorized_official_last_name": "SWAN",
        "authorized_official_first_name": "ELISA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "855-731-1410"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nampa, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2023; 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.