Healthcare Provider Details

I. General information

NPI: 1962017780
Provider Name (Legal Business Name): B & G WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 01/28/2023
Certification Date: 01/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4848 GREGORY RD STE A
DEXTER MI
48130-9628
US

IV. Provider business mailing address

4848 GREGORY RD STE A
DEXTER MI
48130-9628
US

V. Phone/Fax

Practice location:
  • Phone: 734-726-5421
  • Fax: 949-543-2300
Mailing address:
  • Phone: 734-726-5421
  • Fax: 949-543-2300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JULIE BUMPUS
Title or Position: OWNER
Credential:
Phone: 734-730-8445