MEDICARE: RADIANT HEALTH AND WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1841902574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIANT HEALTH AND WELLNESS

Provider Business Mailing Address
First Line	:	PO BOX 150165
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49515-0165
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1809 PLAINFIELD AVE NE STE A
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-4706
Country	:	US
Telephone Number	:	616-219-0390
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER/CEO
Name	:	DR. CHIAHUI NEILLY
Credential	:	DNP, FNP-BC, PMHNP-B
Telephone Number	:	616-219-0390

Provider Enumeration Date	:	12/13/2022
Last Update Date	:	12/13/2022

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