| Fulfilling Life Pllc | |
|
3 Club Centre Ct Ste B1 Edwardsville IL 62025-3519 | |
| (618) 699-4402 | |
| (618) 590-8199 |
| Full Name | Fulfilling Life Pllc |
|---|---|
| Speciality | Specialist |
| Location | 3 Club Centre Ct Ste B1, Edwardsville, Illinois |
| Authorized Official Name and Position | Di'ara Woods (CEO) |
| Authorized Official Contact | 3147498906 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fulfilling Life Pllc 403 Glen Carbon Rd Glen Carbon IL 62034-2965 Ph: (314) 749-8906 | Fulfilling Life Pllc 3 Club Centre Ct Ste B1 Edwardsville IL 62025-3519 Ph: (618) 699-4402 |
| NPI Number | 1922796408 |
|---|---|
| Provider Enumeration Date | 04/24/2023 |
| Last Update Date | 04/24/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922796408 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 174400000X | Specialist | (* (Not Available)) | Primary |
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