| NPI | 1861982423 |
|---|---|
| Former Legal Business Name | OMNI WELLNESS GROUP |
| Entity Type | Organization |
| Authorized Contact | SHEILA PETREQUIN Billing Manager 937-438-9500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2018-05-18 |
| Last Update Date | 2023-10-30 |