Lifestyle Wellness LLC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

LIFESTYLE WELLNESS LLC

Practice address

3192 N Windsong Dr
Prescott Valley, AZ 86314-2239

Phone

(928) 288-0500

NPI assigned

Jul 20, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Colleen Petullo, NP

Title

Nurse Practitioner

Phone

(928) 288-0500

Specialties & licenses 1

Addresses

Other names 1

• Lifestyle Wellness LLC Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jerome Alexander Longoria, DC

  • Chiropractor
  • Prescott Valley, AZ
  • NPI 1396241394
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1658275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661126400000",
    "number": "1750016192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3192 N WINDSONG DR",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863142239",
            "telephone_number": "928-288-0500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3192 N WINDSONG DR",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863142239",
            "telephone_number": "928-288-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESTYLE WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-20",
        "last_updated": "2022-08-22",
        "certification_date": "2022-08-22",
        "status": "A",
        "authorized_official_last_name": "PETULLO",
        "authorized_official_first_name": "COLLEEN",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "928-288-0500",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lifestyle Wellness LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Life Transformation Recovery
• Life Transformation Recovery
• Life Transformation Recovery
• Lifecare Solutions, Inc.
• Lifestyle Chiropractic LLC
• Cheryl Ligon
• Lincare Inc.
• Deborah Lindley
• Kaeden Litchfield
• Dennis L Little, M.D.

• Nurse Practitioner in Prescott Valley, AZ
• Providers in Prescott Valley, AZ by specialty
• Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.