Provider Demographics
NPI:1730977240
Name:HEALTHYWISE MEDICAL LLC
Entity type:Organization
Organization Name:HEALTHYWISE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BREGQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:900-000-0009
Mailing Address - Street 1:1740 DELL RANGE BLVD # H291
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-4961
Mailing Address - Country:US
Mailing Address - Phone:900-000-0009
Mailing Address - Fax:900-000-0009
Practice Address - Street 1:1401 AIRPORT PKWY STE 100
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-1522
Practice Address - Country:US
Practice Address - Phone:900-000-0009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-26
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty