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 |