Provider Demographics
NPI:1164398715
Name:WELL-I-AM
Entity type:Organization
Organization Name:WELL-I-AM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:JARDINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-500-6529
Mailing Address - Street 1:1757 SHIVWITS DR
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7746
Mailing Address - Country:US
Mailing Address - Phone:435-500-6529
Mailing Address - Fax:312-586-7638
Practice Address - Street 1:1757 SHIVWITS DR
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7746
Practice Address - Country:US
Practice Address - Phone:435-500-6529
Practice Address - Fax:312-586-7638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty