| NPI | 1750016192 |
|---|---|
| Doing Business As | LIFESTYLE WELLNESS LLC |
| Entity Type | Organization |
| Authorized Contact | COLLEEN PETULLO Nurse Practitioner 928-288-0500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Enumeration Date | 2022-07-20 |
| Last Update Date | 2022-08-22 |