MEDICARE: CONCIERGE HEALTH LLC

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	363LA2200X	Adult Health Nurse Practitioner

General Provider Information

NPI Number	:	1851144901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONCIERGE HEALTH LLC

Provider Business Mailing Address
First Line	:	1600 MCCULLOCH BLVD N STE 4A
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-0959
Country	:	US
Telephone Number	:	928-486-6135
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 MCCULLOCH BLVD N STE 4A
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-0959
Country	:	US
Telephone Number	:	928-486-6135
Fax Number	:

Authorized Official
Title or Position	:	NP/OWNER
Name	:	MICHELLE WITZEL
Credential	:	NP
Telephone Number	:	928-486-6135

Provider Enumeration Date	:	04/09/2024
Last Update Date	:	03/03/2026

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