Provider Demographics
NPI:1366295198
Name:DIVINE WELLNESS WALK IN CLINIC
Entity type:Organization
Organization Name:DIVINE WELLNESS WALK IN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLENKA
Authorized Official - Middle Name:ALLA
Authorized Official - Last Name:MIROSLAVNA-STEFANIYUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-518-0992
Mailing Address - Street 1:181 CHARLES DR
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-1914
Mailing Address - Country:US
Mailing Address - Phone:724-518-0992
Mailing Address - Fax:
Practice Address - Street 1:3019 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:N VERSAILLES
Practice Address - State:PA
Practice Address - Zip Code:15137-1485
Practice Address - Country:US
Practice Address - Phone:724-518-0992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care