Healthcare Provider Details

I. General information

NPI: 1336986165
Provider Name (Legal Business Name): TWO WORLDS WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 S STATE ST STE 215
ANN ARBOR MI
48104-7103
US

IV. Provider business mailing address

2800 S STATE ST STE 215
ANN ARBOR MI
48104-7103
US

V. Phone/Fax

Practice location:
  • Phone: 734-547-3990
  • Fax: 734-547-3980
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PAULA ELIZABETH ESTEVA SLACK
Title or Position: OWNER/CONTROLLER
Credential: DNP
Phone: 734-255-6706