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Individual provider Active NPI Health & Wellness Coach · Macomb, MI

NPI 1053007641 · NPPES record last updated Apr 17, 2023

Key facts

NPI
1053007641
Entity type
Individual (NPI type 1)
Primary specialty
Health & Wellness Coach 171400000X
License
A-3694981 (MI)
Practice address
54642 Hibiscus Dr
Macomb, MI 48042-2263
Phone
(586) 246-1123
NPI assigned
Apr 17, 2023
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
A-3694981MIMDHealth & Wellness Coach
5502002045MIMDPhysical Therapy Assistant

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 5502002045 MI
Health & Wellness Coach 171400000X A-3694981 MI Yes

Addresses

Primary practice location

54642 Hibiscus Dr
Macomb, MI 48042-2263

Mailing address

54642 Hibiscus Dr
Macomb, MI 48042-2263
Phone (586) 246-1123

Other providers in Macomb, MI

All providers in Macomb, MI · Health & Wellness Coach in Michigan

Sources for this page

Verify at the official NPI Registry.