Evolving Wellness Corp

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

EVOLVING WELLNESS CORP

Practice address

2645 Harlem St Ste 1T
Eau Claire, WI 54701-2504

Phone

(715) 514-4233

NPI assigned

Jul 15, 2021

Organization subpart

No

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

Authorized official

Name

Ms. Laura Jean Berndt

Title

Executive Director

Phone

(715) 523-0617

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1626307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626307200000",
    "number": "1760054068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2645 HARLEM ST STE 1T",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547012504",
            "telephone_number": "715-514-4233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2645 HARLEM ST STE 1T",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547012504",
            "telephone_number": "715-514-4233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVOLVING WELLNESS CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-15",
        "last_updated": "2021-07-15",
        "certification_date": "2021-07-15",
        "status": "A",
        "authorized_official_last_name": "BERNDT",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "715-523-0617",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Leonard C Ezenagu, MD

• Clinic/Center in Eau Claire, WI
• Providers in Eau Claire, WI by specialty
• Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 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.