Healthcare Provider Details

I. General information

NPI: 1477485712
Provider Name (Legal Business Name): FORTUNE WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5470 S LAKESHORE DR
TEMPE AZ
85283-2173
US

IV. Provider business mailing address

4502 W KRISTAL WAY
GLENDALE AZ
85308-5420
US

V. Phone/Fax

Practice location:
  • Phone: 623-594-5447
  • Fax:
Mailing address:
  • Phone: 623-594-5447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: AEMARIJN MARLOW FORTUNE
Title or Position: OWNER
Credential: D.AC
Phone: 623-594-5447