Provider Demographics
NPI:1366806457
Name:ADVANCED WELLNESS CENTER, P.C.
Entity type:Organization
Organization Name:ADVANCED WELLNESS CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLOSSER
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, FNP, ARNP
Authorized Official - Phone:563-556-6292
Mailing Address - Street 1:2442 MEINEN CT
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-2787
Mailing Address - Country:US
Mailing Address - Phone:563-556-6292
Mailing Address - Fax:563-588-6286
Practice Address - Street 1:2442 MEINEN CT
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-2787
Practice Address - Country:US
Practice Address - Phone:563-556-6292
Practice Address - Fax:563-588-6286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-05
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA100449261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care