Healthcare Provider Details

I. General information

NPI: 1851144901
Provider Name (Legal Business Name): CONCIERGE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2024
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MCCULLOCH BLVD N STE 4A
LAKE HAVASU CITY AZ
86403-0959
US

IV. Provider business mailing address

1600 MCCULLOCH BLVD N STE 4A
LAKE HAVASU CITY AZ
86403-0959
US

V. Phone/Fax

Practice location:
  • Phone: 928-486-6135
  • Fax:
Mailing address:
  • Phone: 928-486-6135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: MICHELLE WITZEL
Title or Position: NP
Credential: NP
Phone: 623-289-7223