NPIMap

Organization Active NPI

Grand Wellness, LLC

  • Acupuncturist
  • Grand Rapids, MI
National Provider Identifier
1821465956
Registry record updated Jun 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
AcupuncturistTaxonomy code 171100000X
License
5401000137 Issued in MI
Legal business name
GRAND WELLNESS, LLC
Practice address
751 Kenmoor Ave SE Ste H
Grand Rapids, MI 49546-2391
Phone
(616) 466-4175
Fax
(616) 259-4855
NPI assigned
Aug 24, 2015
Last updated
Jun 20, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2021

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

Authorized official

Name
Ms. Vikki Nestico, L. AC.NPI 1255757803
Title
Acupuncturist
Phone
(917) 376-4001

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acupuncturist 171100000X 5401000137 MI Primary

Addresses

Primary practice location

751 Kenmoor Ave SE Ste H
Grand Rapids, MI 49546-2391

Mailing address

1531 Lake Grove Ave SE
East Grand Rapids, MI 49506-4741

National Provider Directory

National Provider Directory

Locations

751 Kenmoor Ave SE
Ste H
Grand Rapids, MI 49546
Phone (616) 466-4175

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1440374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624147200000",
    "number": "1821465956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1531 LAKE GROVE AVE SE",
            "city": "EAST GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495064741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 KENMOOR AVE SE STE H",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462391",
            "telephone_number": "616-466-4175",
            "fax_number": "616-259-4855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-24",
        "last_updated": "2021-06-20",
        "certification_date": "2021-06-20",
        "status": "A",
        "authorized_official_last_name": "NESTICO",
        "authorized_official_first_name": "VIKKI",
        "authorized_official_title_or_position": "ACUPUNCTURIST",
        "authorized_official_telephone_number": "917-376-4001",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "L. AC."
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "MI",
            "license": "5401000137",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2021; 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.