Provider Demographics
NPI:1578383295
Name:WELLNESS EDGE
Entity type:Organization
Organization Name:WELLNESS EDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:VOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:402-802-4226
Mailing Address - Street 1:1303 S 72ND ST STE 106
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-1605
Mailing Address - Country:US
Mailing Address - Phone:402-802-4226
Mailing Address - Fax:
Practice Address - Street 1:1303 S 72ND ST STE 106
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-1605
Practice Address - Country:US
Practice Address - Phone:402-802-4226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-16
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty